Sternal Resections: An Attempt to Find the Ideal Reconstruction Method
<i>Background and Objectives:</i> Sternal resections, although rare, pose significant challenges for the reconstruction of large anterior chest wall defects. Both stability and soft tissue reconstruction are essential for preventing respiratory complications and ensure structural stabili...
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MDPI AG
2025-04-01
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| Online Access: | https://www.mdpi.com/1648-9144/61/4/763 |
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| author | Emanuel Palade Ioana-Medeea Titu Lucian Fodor Ion Mircea Ciorba Ion Jentimir Florin Teterea Monica Mlesnite Ioana Tichil |
| author_facet | Emanuel Palade Ioana-Medeea Titu Lucian Fodor Ion Mircea Ciorba Ion Jentimir Florin Teterea Monica Mlesnite Ioana Tichil |
| author_sort | Emanuel Palade |
| collection | DOAJ |
| description | <i>Background and Objectives:</i> Sternal resections, although rare, pose significant challenges for the reconstruction of large anterior chest wall defects. Both stability and soft tissue reconstruction are essential for preventing respiratory complications and ensure structural stability. Despite the variety of techniques proposed, no consensus exists on an optimal method. Herein, we present our institutional experience using the novel “spider-web” technique combined with an anterolateral thigh (ALT) free flap for chest wall and soft tissue reconstruction following extensive sternectomies. <i>Materials and Methods:</i> Between January 2023 and November 2024, five female patients underwent partial or total sternectomy for oncologic indications. Chest wall stability was restored using the “spider-web” technique–based on non-resorbable polyester threads arranged in a geometric web pattern reinforced with polypropylene mesh–followed by soft tissue reconstruction using a free ALT myocutaneous flap. Data on demographics, surgical details, postoperative outcomes, and complications were prospectively analyzed. <i>Results:</i> Resections included two partial and three total sternectomies. The mean operative time was 385 min (range: 330–435 min). All patients were extubated postoperatively without the need for respiratory support. The “spider-web” construct provided adequate chest wall stability with no cases of paradoxical movement or chronic pain. No flap loss occurred; one case required revision for venous thrombosis, and one hematoma at the donor site was evacuated. No infections or wound dehiscence were observed. The median hospital stay was 11 days (SD ± 1.67 days), and 30-day mortality was 0%. Median follow-up was 10 months (SD ± 6.55 months), without long-term complications. <i>Conclusions:</i> The “spider-web” technique, combined with ALT myocutaneous free flap, is a simple, reliable, and cost-effective method for the reconstructing extensive chest wall defects following sternectomy. Its technical versatility and favorable outcomes suggest it as a valuable option, offering both structural stability and soft tissue coverage with minimal morbidity. |
| format | Article |
| id | doaj-art-fbcd54c21dd044cb8f038e4cb14f5b12 |
| institution | OA Journals |
| issn | 1010-660X 1648-9144 |
| language | English |
| publishDate | 2025-04-01 |
| publisher | MDPI AG |
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| series | Medicina |
| spelling | doaj-art-fbcd54c21dd044cb8f038e4cb14f5b122025-08-20T02:28:37ZengMDPI AGMedicina1010-660X1648-91442025-04-0161476310.3390/medicina61040763Sternal Resections: An Attempt to Find the Ideal Reconstruction MethodEmanuel Palade0Ioana-Medeea Titu1Lucian Fodor2Ion Mircea Ciorba3Ion Jentimir4Florin Teterea5Monica Mlesnite6Ioana Tichil7Department of Surgery, Iuliu Hatieganu University of Medicine and Pharmacy, 400000 Cluj-Napoca, RomaniaDepartment of Surgery, Iuliu Hatieganu University of Medicine and Pharmacy, 400000 Cluj-Napoca, RomaniaInterservisan Medical and Surgical Center, 400431 Cluj-Napoca, RomaniaThoracic Surgery Clinic, Leon Daniello Clinical Hospital of Pneumology, 400371 Cluj-Napoca, RomaniaThoracic Surgery Clinic, Leon Daniello Clinical Hospital of Pneumology, 400371 Cluj-Napoca, RomaniaThoracic Surgery Clinic, Leon Daniello Clinical Hospital of Pneumology, 400371 Cluj-Napoca, RomaniaThoracic Surgery Clinic, Leon Daniello Clinical Hospital of Pneumology, 400371 Cluj-Napoca, RomaniaDepartment 1—Morpho-Functional Sciences, Iuliu Hatieganu University of Medicine and Pharmacy, 400006 Cluj-Napoca, Romania<i>Background and Objectives:</i> Sternal resections, although rare, pose significant challenges for the reconstruction of large anterior chest wall defects. Both stability and soft tissue reconstruction are essential for preventing respiratory complications and ensure structural stability. Despite the variety of techniques proposed, no consensus exists on an optimal method. Herein, we present our institutional experience using the novel “spider-web” technique combined with an anterolateral thigh (ALT) free flap for chest wall and soft tissue reconstruction following extensive sternectomies. <i>Materials and Methods:</i> Between January 2023 and November 2024, five female patients underwent partial or total sternectomy for oncologic indications. Chest wall stability was restored using the “spider-web” technique–based on non-resorbable polyester threads arranged in a geometric web pattern reinforced with polypropylene mesh–followed by soft tissue reconstruction using a free ALT myocutaneous flap. Data on demographics, surgical details, postoperative outcomes, and complications were prospectively analyzed. <i>Results:</i> Resections included two partial and three total sternectomies. The mean operative time was 385 min (range: 330–435 min). All patients were extubated postoperatively without the need for respiratory support. The “spider-web” construct provided adequate chest wall stability with no cases of paradoxical movement or chronic pain. No flap loss occurred; one case required revision for venous thrombosis, and one hematoma at the donor site was evacuated. No infections or wound dehiscence were observed. The median hospital stay was 11 days (SD ± 1.67 days), and 30-day mortality was 0%. Median follow-up was 10 months (SD ± 6.55 months), without long-term complications. <i>Conclusions:</i> The “spider-web” technique, combined with ALT myocutaneous free flap, is a simple, reliable, and cost-effective method for the reconstructing extensive chest wall defects following sternectomy. Its technical versatility and favorable outcomes suggest it as a valuable option, offering both structural stability and soft tissue coverage with minimal morbidity.https://www.mdpi.com/1648-9144/61/4/763sternectomychest wall reconstructionspider-web techniqueanterolateral thigh flapsoft tissue reconstruction |
| spellingShingle | Emanuel Palade Ioana-Medeea Titu Lucian Fodor Ion Mircea Ciorba Ion Jentimir Florin Teterea Monica Mlesnite Ioana Tichil Sternal Resections: An Attempt to Find the Ideal Reconstruction Method Medicina sternectomy chest wall reconstruction spider-web technique anterolateral thigh flap soft tissue reconstruction |
| title | Sternal Resections: An Attempt to Find the Ideal Reconstruction Method |
| title_full | Sternal Resections: An Attempt to Find the Ideal Reconstruction Method |
| title_fullStr | Sternal Resections: An Attempt to Find the Ideal Reconstruction Method |
| title_full_unstemmed | Sternal Resections: An Attempt to Find the Ideal Reconstruction Method |
| title_short | Sternal Resections: An Attempt to Find the Ideal Reconstruction Method |
| title_sort | sternal resections an attempt to find the ideal reconstruction method |
| topic | sternectomy chest wall reconstruction spider-web technique anterolateral thigh flap soft tissue reconstruction |
| url | https://www.mdpi.com/1648-9144/61/4/763 |
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