Surgical management of sternal tumours-a decade of experience from a tertiary care centre in India

Abstract

Tumours of the sternum can be either primary or secondary with malignancy being the most common etiology. Wide local excision of these tumours results in a midline defect which pose a unique challenge for reconstruction. As limited data on the management of these tumours exists in the literature, we hereby report 14 consecutive patients who were treated at our institute between January 2009 to December 2020. Most of them were malignant with majority of them, 11 (78%) patients, with manubrial involvement requiring partial sternectomy. Overall, the average defect size was 75 cm². Reconstruction of the chest wall defect was done using a semi-rigid fixation: mesh and suture stabilization in 3 (21%) or suture stabilization in 7 (50%) and without mesh or suture stabilization in 3 (21%) patients. Rigid fixation with polymethyl methacrylate (PMMA) was done for one patient (7%). Pectoralis major advancement flap was most commonly used for soft tissue reconstruction with flap necrosis noted in one patient (7%). There was no peri-operative mortality and one patient required prolonged post-operative ventilation. On a median follow-up of 37.5 months, one patient (7%) had a recurrence. Sternal defects after surgical resection reconstructed with semi-rigid fixation and suture stabilization render acceptable post-operative outcomes.

Keywords: Chondrosarcoma; Manubrium; Plastic surgery; Reconstruction; Surgical mesh.

Fig. 1

Computed tomography of the thorax: mediastinal (a) and bone window (b) showing lytic lesion involving the manubrium with a large exophytic soft tissue component and areas of calcification. c Photomicrograph displaying lobules of mildly cellular cartilage with minimal to mild atypia, H&E, 4×. d Photomicrograph displaying chondrocytes with minimal to mild atypia, H&E, 20×

Fig. 2

a Clinical photograph of a patient with a sternal tumour involving the upper sternum. b Clinical photograph of the same patient, after partial resection of the sternum. c Clinical photograph of the same patient showing reconstruction of the defect with polypropylene mesh. d Pictorial depiction of the interclavicular stitch