Sternal Reconstruction Using a Fibula Allograft

Bone allograft transplantation represents a new option for anterior chest wall reconstruction. The disadvantages of synthetic materials are: excessive rigidity with risk of erosion of adjacent structures, the risk of infection, insufficient strength, immunological reaction, lack of incorporation into the host tissue, and sub-optimal radiological transparency. Moreover, the use of synthetic materials is not indicated in cases of an infected surgical site. Biological materials are able to fill large defects. Nevertheless, rigid synthetic materials are required in association with muscle flaps to recreate the biomechanical characteristics of the chest wall, to avoid parodoxical movement and respiratory insufficiency, and to protect the chest organs. Alternatively, biological materials can be used for chest wall reconstruction with optimal biomechanical characteristics that are fully compatible, such as bone autografts. Bone grafts also act as a scaffold for osteoprogenitor cells and bone formation. Bone allografts have the same advantages as autografts in term of infection risk, compatibility, and host tissue incorporation. Bone allografts do not require additional incisions or tissue resection for harvesting, and are often readily available from a tissue bank.