{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,4,4]],"date-time":"2026-04-04T21:14:01Z","timestamp":1775337241574,"version":"3.50.1"},"reference-count":29,"publisher":"MDPI AG","issue":"4","license":[{"start":{"date-parts":[[2025,4,21]],"date-time":"2025-04-21T00:00:00Z","timestamp":1745193600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"Iuliu Hatieganu University of Medicine and Pharmacy, Cluj-Napoca"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Medicina"],"abstract":"<jats:p>Background and Objectives: Sternal resections, although rare, pose significant challenges for the reconstruction of large anterior chest wall defects. Both stability and soft tissue reconstruction are essential for preventing respiratory complications and ensure structural stability. Despite the variety of techniques proposed, no consensus exists on an optimal method. Herein, we present our institutional experience using the novel \u201cspider-web\u201d technique combined with an anterolateral thigh (ALT) free flap for chest wall and soft tissue reconstruction following extensive sternectomies. Materials and Methods: Between January 2023 and November 2024, five female patients underwent partial or total sternectomy for oncologic indications. Chest wall stability was restored using the \u201cspider-web\u201d technique\u2013based on non-resorbable polyester threads arranged in a geometric web pattern reinforced with polypropylene mesh\u2013followed by soft tissue reconstruction using a free ALT myocutaneous flap. Data on demographics, surgical details, postoperative outcomes, and complications were prospectively analyzed. Results: Resections included two partial and three total sternectomies. The mean operative time was 385 min (range: 330\u2013435 min). All patients were extubated postoperatively without the need for respiratory support. The \u201cspider-web\u201d construct provided adequate chest wall stability with no cases of paradoxical movement or chronic pain. No flap loss occurred; one case required revision for venous thrombosis, and one hematoma at the donor site was evacuated. No infections or wound dehiscence were observed. The median hospital stay was 11 days (SD \u00b1 1.67 days), and 30-day mortality was 0%. Median follow-up was 10 months (SD \u00b1 6.55 months), without long-term complications. Conclusions: The \u201cspider-web\u201d technique, combined with ALT myocutaneous free flap, is a simple, reliable, and cost-effective method for the reconstructing extensive chest wall defects following sternectomy. Its technical versatility and favorable outcomes suggest it as a valuable option, offering both structural stability and soft tissue coverage with minimal morbidity.<\/jats:p>","DOI":"10.3390\/medicina61040763","type":"journal-article","created":{"date-parts":[[2025,4,21]],"date-time":"2025-04-21T04:57:11Z","timestamp":1745211431000},"page":"763","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":2,"title":["Sternal Resections: An Attempt to Find the Ideal Reconstruction Method"],"prefix":"10.3390","volume":"61","author":[{"given":"Emanuel","family":"Palade","sequence":"first","affiliation":[{"name":"Department of Surgery, Iuliu Hatieganu University of Medicine and Pharmacy, 400000 Cluj-Napoca, Romania"},{"name":"Thoracic Surgery Clinic, Leon Daniello Clinical Hospital of Pneumology, 400371 Cluj-Napoca, Romania"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3577-8341","authenticated-orcid":false,"given":"Ioana-Medeea","family":"Titu","sequence":"additional","affiliation":[{"name":"Department of Surgery, Iuliu Hatieganu University of Medicine and Pharmacy, 400000 Cluj-Napoca, Romania"},{"name":"Thoracic Surgery Clinic, Leon Daniello Clinical Hospital of Pneumology, 400371 Cluj-Napoca, Romania"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Lucian","family":"Fodor","sequence":"additional","affiliation":[{"name":"Interservisan Medical and Surgical Center, 400431 Cluj-Napoca, Romania"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ion Mircea","family":"Ciorba","sequence":"additional","affiliation":[{"name":"Thoracic Surgery Clinic, Leon Daniello Clinical Hospital of Pneumology, 400371 Cluj-Napoca, Romania"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ion","family":"Jentimir","sequence":"additional","affiliation":[{"name":"Thoracic Surgery Clinic, Leon Daniello Clinical Hospital of Pneumology, 400371 Cluj-Napoca, Romania"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Florin","family":"Teterea","sequence":"additional","affiliation":[{"name":"Thoracic Surgery Clinic, Leon Daniello Clinical Hospital of Pneumology, 400371 Cluj-Napoca, Romania"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Monica","family":"Mlesnite","sequence":"additional","affiliation":[{"name":"Thoracic Surgery Clinic, Leon Daniello Clinical Hospital of Pneumology, 400371 Cluj-Napoca, Romania"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ioana","family":"Tichil","sequence":"additional","affiliation":[{"name":"Department 1\u2014Morpho-Functional Sciences, Iuliu Hatieganu University of Medicine and Pharmacy, 400006 Cluj-Napoca, Romania"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1968","published-online":{"date-parts":[[2025,4,21]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"1653","DOI":"10.1016\/j.athoracsur.2016.05.072","article-title":"The Influence of Reconstructive Technique on Perioperative Pulmonary and Infectious Outcomes Following Chest Wall Resection","volume":"102","author":"Spicer","year":"2016","journal-title":"Ann. 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