Comparison Of Reconstruction Techniques, Surgical Timing, And Pulmonary Function Outcomes In Sternal Reconstruction: A Systematic Review And Meta-analysis

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PURPOSE: Sternal defects after cardiac surgery or tumor resection pose high risks for severe complications and compromise postoperative function. Autologous flap reconstruction is widely used for chest wall restoration, yet the optimal timing and influence on long-term pulmonary outcomes remain poorly understood. This meta-analysis compares various sternal reconstruction techniques and surgical timing, evaluating their effect on survival, major complications, and pulmonary function. METHODS: A systematic review was conducted using PubMed, EMBASE, Cochrane Library, Scopus, and Google Scholar from inception to October 4, 2025. Studies included were cohort studies, case-control studies, or case series (5 patients) reporting outcomes of sternal reconstruction using autologous flaps or hybrid techniques with synthetic materials. Immediate reconstruction referred to repair during the initial surgery, while delayed reconstruction occurred in a scheduled, later operation. Extracted outcomes included mortality, wound dehiscence, and changes in pulmonary function between preoperative and postoperative periods. Pooled estimates were generated using random-effects models, with heterogeneity evaluated by I². RESULTS: Of 2,935 studies identified, 614 underwent full-text review, and 18 met the inclusion criteria and provided sufficient data (1,846 patients). Delayed sternal reconstruction was linked to a notable reduction in mortality (OR 0.34, 95% CI [0.21, 0.55], p0.0001, I²=1%) as well as a decreased risk of wound dehiscence (OR 0.41, 95% CI [0.19, 0.87], p=0.02, I²=24%). Pulmonary function outcomes were improved following sternal reconstruction, with patients experiencing higher postoperative FVC% (OR 6.49, 95% CI [1.88, 10.93], p=0.0006, I²=16%) and increased DLCO% (OR 9.28, 95% CI [3.29, 15.3], p=0.002, I²=0%) when compared to their preoperative measurements. CONCLUSION: Autologous flap reconstruction is the gold standard for repairing sternal defects following cardiac surgery or oncologic resection. Deliberately delaying the timing of reconstruction may improve critical postoperative outcomes, including mortality and wound complications. In addition, pulmonary function may be significantly enhanced following sternal reconstruction. These findings have major clinical implications for guiding reconstructive surgeons toward practices that optimize both immediate and long-term recovery. *Source: https://ps-rc.org/meeting/Program/2026/MS37.cgi*

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