[Discussion on hot topics of skeletal sternal reconstruction].

Abstract

Sternum is an important constituent of the thoracic cage, and a pivotal part of the anterior chest wall. When a considerable portion of the sternum needs to be resected, in order to protect the vital organs beneath, restore the anatomical structure and physiological function, reconstruction is unavoidable. Sternal reconstruction consists of two related parts: skeletal and soft tissue reconstruction. Skeletal reconstruction uses materials such as autograft or allograft of bones, metallic plates, sandwich patch, non-rigid patches, bio-synthetic patches and three-dimensional printing prosthesis. Each has its advantages and disadvantages. For example, autogenous bone transplantation is limited by the source of donor bones and surgical trauma; allograft bone transplantation demands cryopreservation and is susceptible to infection; titanium plate cannot be placed overlapped; "sandwich" patch is susceptible to local fluid accumulation and infection; non-rigid patches cannot provide enough mechanical support; the design and manufacture of three-dimensional printing prosthesis is complicated, time consuming and expensive, and cannot be adjusted due to change of extent of resection during operation. The modularized prosthesis system is a promising new technique developed on the basis of titanium plate. It is divided into standard components of different sizes that can be selected according to operational requirement and easily assembled. Until now, no perfect method or material has been found to imitate the autogenous sternum. Soft tissue reconstruction is a prerequisite to the success of large scale skeletal reconstruction of the sternum.