Technique for Upper Sternal Allograft Implantation

A young female with a single metastasis at the level of the upper portion of the sternum underwent surgical excision of the sternum followed by sternal allograft implantation. The use of a sternal allograft provides excellent functional and cosmetic results.

Neoplastic involvement of the sternum is a challenging situation. Surgical treatment is indicated in the case of controlled primary disease, absence of other metastases, and/or severe comorbidities limiting the patient’s life expectancy. Wide resection margins are needed for an effective operation, and reconstruction of the thoracic cage is important to ensure good postoperative respiratory function. In addition, the sternoclavicular junctions are involved in the normal mobility of the shoulder girdle and support of the axial skeleton. Transosseous hi-tension sutures were used to stabilize and reconstruct the continuity between the neo-sternum and the clavicles. The surgical technique of sternal excision and reconstruction with a sternal allograft and titanium bars and screws is a new option for treatment of neoplastic or infectious involvement of the sternum. Bone allografts have optimal biomechanical characteristics, are fully biocompatible, and carry a low risk of infection. Sternal allografts also act as a scaffold for osteoprogenitor cells and bone formation with good host tissue incorporation. The reported technique is simple and reproducible. This video gives details demonstrating the authors’ technique of sternal allograft implantation.