Sternal reconstruction with synthetic mesh and metallic plates for high grade tumours of the chest wall

Abstract

Objective: To present our experience of reconstruction of the chest wall after sternectomy for high grade tumours.

Design: Retrospective study.

Setting: University hospital, Italy.

Subjects: 18 patients who required sternectomy for high grade tumours.

Interventions: After wide resection of the tumour the sternum and chest wall were reconstructed with polypropylene (Marlex) mesh and mouldable titanium plates. Pedicled muscle flaps were used to complete the reconstruction.

Main outcome measures: Morbidity, mortality, and outcome.

Results: The 18 tumours were chondrosarcomas (n = 7); osteosarcomas, radiation-induced sarcomas, and local recurrences after breast cancer (n = 2 each); and angiosarcoma, Ewing sarcoma, liposarcoma, malignant fibrous histiocytoma, and metastatic renal carcinoma (n = 1 each). One patient died in hospital. Two patients developed wound infections, one required repeated aspirations of a pleural effusion, and one patient later developed loosening of the plate that had been sutured to the clavicular stump. At the time of follow-up (mean 32 months, range 12-74) 16 patients were alive, all of whom had returned to their normal life style.

Conclusions: The technique is easy to follow and has the advantages of a short hospital stay and good local control. It obviates the need for postoperative mechanical ventilation, and means that patients are not prevented from working because of incapacity.