Partial Sternal Resections in Primary and Metastatic Tumors with Nonrigid Reconstruction of Chest Wall

Abstract

Primary sternal tumors are rare and are often metastatic from neoplasms of lung, breast, thyroid, and kidney. A radical resection is indicated for their management. In recent years many rigid reconstructions are described to prevent pulmonary complications and for protection of intra -thoracic organs. It is known that chest wall is a stable yet flexible structure and hence the optimal functional outcome in spite of rigid reconstructions remains an ongoing challenge. We hypothesized that partial sternal resections does not need a rigid reconstruction and studied the functional outcome in series of five cases where simple reconstructions are done.We did standard excision of sternum and ribs depending on the site. Immediate reconstruction was done using available myocutaneous flaps (TRAM flap, Pectoralis major muscle flap and polypropylene mesh). All cases had smooth postoperative course, had excellent coverage, chest wall stability and minimal donor site morbidity. All had a short hospital stay period (8-12 days) with good functional outcome. We do hereby propose nonrigid reconstruction for partial sternal defects as a good and safe alternative.

Keywords: Neoplasms; Resection; Tumor.

Fig. 1

Sternal tumor

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Partial sternal resection

Fig. 3

Defect following resection of tumor

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Reconstruction with mesh

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Mobilization of P. Major

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Mobilized bilateral P. Major muscles

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Appearance 10 days postoperatively

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CT scan showing ulcer

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Soft tissue tumor with ulceration

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Incision for the tumor

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Resection of the tumor

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Defect following resection

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Vertical rectus abdominus flap (VRAM)

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VRAM flap in the defect

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Three days postoperative

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Preoperative picture showing resection

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Defect following resection

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Reconstruction with mesh

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Third postoperative day

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Preoperative picture

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Resection of the tumor

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Mobilization of P. major

Fig. 23

Seven days postoperative