CC BY-NC 4.0 · Arch Plast Surg 2021; 48(05): 498-502
DOI: 10.5999/aps.2021.00682
Breast/Trunk
Case Report

Sternal defect reconstruction using a double-barrel vascularized free fibula flap: a case report

Division of Plastic Surgery, Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, TX, USA
,
Division of Plastic Surgery, Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, TX, USA
,
Division of Plastic Surgery, Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, TX, USA
,
Division of Plastic Surgery, Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, TX, USA
,
Division of Plastic Surgery, Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, TX, USA
› Author Affiliations

Total and subtotal sternectomy oncological defects can result in large deficits in the chest wall, disrupting the biomechanics of respiration. Reviewing the current literature involving respiratory function and rib motion after sternectomy, autologous rigid reconstruction was determined to provide the optimal reconstructive option. We describe a novel technique for sternal defect reconstruction utilizing a double-barrel, longitudinally oriented, vascularized free fibula flap associated with rib titanium plates fixation. Our reconstructive approach was able to deliver a physiological reconstruction, providing rigid support and protection while allowing articulation with adjacent ribs and preservation of chest wall mechanics.



Publication History

Received: 26 April 2021

Accepted: 07 July 2021

Article published online:
19 March 2022

© 2021. The Korean Society of Plastic and Reconstructive Surgeons. This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonCommercial License, permitting unrestricted noncommercial use, distribution, and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes. (https://creativecommons.org/licenses/by-nc/4.0/)

Thieme Medical Publishers, Inc.
333 Seventh Avenue, 18th Floor, New York, NY 10001, USA

 
  • REFERENCES

  • 1 Sanna S, Brandolini J, Pardolesi A. Materials and techniques in chest wall reconstruction: a review. J Vis Surg 2017; 3: 95
  • 2 Nagasao T, Kasai S, Shimizu Y. et al. A biomechanical study of relationship between sternum defect patterns and thoracic respiration. Comput Assist Surg (Abingdon) 2016; 21: 1-8
  • 3 Butterworth JA, Garvey PB, Baumann DP. et al. Optimizing reconstruction of oncologic sternectomy defects based on surgical outcomes. J Am Coll Surg 2013; 217: 306-16
  • 4 Fabre D, El Batti S, Singhal S. et al. A paradigm shift for sternal reconstruction using a novel titanium rib bridge system following oncological resections. Eur J Cardiothorac Surg 2012; 42: 965-70
  • 5 Arai K, Toh S, Tsubo K. et al. Complications of vascularized fibula graft for reconstruction of long bones. Plast Reconstr Surg 2002; 109: 2301-6
  • 6 Minami A, Kasashima T, Iwasaki N. et al. Vascularised fibular grafts: an experience of 102 patients. J Bone Joint Surg Br 2000; 82: 1022-5
  • 7 Grabert S, Erlebach M, Will A. et al. Unexpected results after sternal reconstruction with plates, cables and cannulated screws. Interact Cardiovasc Thorac Surg 2016; 22: 663-7
  • 8 Cicilioni Jr OJ, Stieg 3rd FH, Papanicolaou G. Sternal wound reconstruction with transverse plate fixation. Plast Reconstr Surg 2005; 115: 1297-303
  • 9 Drinnon KD, Sherali S, Cox CT. et al. Sternal tumor resection and reconstruction using iliac crest autograft. Plast Reconstr Surg Glob Open 2020; 8: e3002
  • 10 Haraguchi S, Hioki M, Hisayoshi T. et al. Resection of sternal tumors and reconstruction of the thorax: a review of 15 patients. Surg Today 2006; 36: 225-9
  • 11 Beltrami V, Gidaro G. Resection and reconstruction of the sternum: case report. Thorax 1976; 31: 350-3
  • 12 Ozkan S. The reconstruction of the anterior thorax wall after sternal resection through the combination of autologous fibula graft and metal plate. EJMO 2018; 2: 243-6
  • 13 Nahabedian MY, Riley LH, Greene PS. et al. Sternal stabilization using allograft fibula following cardiac transplantation. Plast Reconstr Surg 2001; 108: 1284-8
  • 14 Houdek MT, Bayne CO, Bishop AT. et al. The outcome and complications of vascularised fibular grafts. Bone Joint J 2017; 99-B: 134-8
  • 15 Wood CB, Shinn JR, Amin SN. Risk of plate removal in free flap reconstruction of the mandible. Oral Oncol 2018; 83: 91-5