Sternal Resections: An Attempt to Find the Ideal Reconstruction Method.

Area of Science:

• Thoracic Surgery
• Reconstructive Surgery
• Oncology

Background:

• Sternal resections for oncologic indications create challenging anterior chest wall defects.
• Reconstruction requires both structural stability and soft tissue coverage to prevent complications.
• Optimal reconstruction methods for extensive sternectomies remain debated.

Purpose of the Study:

• To evaluate the efficacy of the "spider-web" technique combined with anterolateral thigh (ALT) free flap for chest wall reconstruction.
• To assess outcomes and complications in patients undergoing sternectomy and subsequent reconstruction.

Main Methods:

• A prospective analysis of five female patients undergoing sternectomy (partial or total) for oncologic reasons.
• Chest wall reconstruction utilized the "spider-web" technique with polyester threads and polypropylene mesh.
• Soft tissue coverage was achieved using free anterolateral thigh (ALT) myocutaneous flaps.

Main Results:

• The "spider-web" construct provided stable chest walls without paradoxical movement or chronic pain.
• All patients were successfully extubated postoperatively without respiratory support.
• No flap loss occurred; minor complications included one venous thrombosis revision and one donor site hematoma.

Conclusions:

• The "spider-web" technique and ALT free flap provide a simple, reliable, and cost-effective solution for extensive chest wall defects.
• This combined approach offers technical versatility, structural stability, and adequate soft tissue coverage.
• Favorable outcomes and minimal morbidity support its consideration as a valuable reconstructive option.