Use of Allogenic Bone Graft With Sternal Plates for Rib Fixation and Chest Wall Stabilization

A 29-year-old man with massive bilateral pulmonary embolisms sustained a cardiac arrest. He was transferred to the operating room with ongoing chest compressions. Emergent sternotomy was performed, and central cannulation was performed for venoarterial extracorporeal membrane oxygenation. His sternotomy was off the midline, through the right costal cartilages. He was referred to thoracic surgery after decannulation for chest wall repair and stabilization.

The patient was taken to the operating room, positioned supine, and prepared for surgery from the neck to pelvis. A small midline laparotomy was performed, and an omental flap was harvested for inlay above the heart. Bilateral pectoralis major muscle advancement flaps were mobilized as an overlay. Rib plating was performed with Synthes® plates. A cryogenically preserved allogenic bone graft was used to bridge the defect between the rib edges for long-term structural support. Cryogenically-preserved allogenic bone grafts are stored in the bone bank at the authors’ institution. They acts as a scaffolding to allow bone in-growth over time. Osteoprogenitor cells migrate from omental fat, leading to bone formation within the graft. Large experiences have been published in orthopedics using this graft type for filling bony defects and restoring skeletal continuity. This graft can be used in thoracic surgery, and its applications should be further explored.