Elsevier

Thoracic Surgery Clinics

Volume 20, Issue 4, November 2010, Pages 529-534
Thoracic Surgery Clinics

Resection and Reconstruction for Primary Sternal Tumors

https://doi.org/10.1016/j.thorsurg.2010.06.002Get rights and content

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Diagnosis

The diagnosis of a sternal tumor is usually made clinically, on the basis of a palpable mass with or without pain in the sternal region. The tumor may be asymptomatic and only detected on imaging documents. The precise location of the tumor and the extent of sternal and chest wall involvement are determined by CT scan and MRI with sagittal views (Fig. 1). The diagnosis must be subsequently confirmed by a biopsy to distinguish primary from metastatic tumors and identify patients with a

Preoperative assessment

The tumor extension and any infiltration of adjacent structures (lung, pericardium, brachiocephalic vein, and superior vena cava) are assessed by conventional axial CT scanning and MRI. PET CT scanning is mostly used to eliminate an extrathoracic metastatic lesion. Every patient is routinely evaluated with cardiopulmonary tests; a severe respiratory insufficiency should be a contra indication for an extensive sternal resection.

The closure of wide sternal defects is planned by both the thoracic

Resection

Wide excision remains the key to success for local control of PMST.

The first step is the skin excision. When the skin and overlying soft tissues are not involved, a vertical elliptical incision encompassing the biopsy site is done. The skin excision must be large in cases of ulceration, previous scars, and if the tumor involves subcutaneous tissues. RIS of the sternum frequently requires a wide cutaneous excision, including previously irradiated surrounding tissues with a margin of at least

Local Complications

The occurrence of a seroma is frequent after reconstruction with PTFE, and it usually resorbs in a few weeks. In the case of large seroma, aspiration will be done under strict aseptic conditions. Wound infection is a major concern occurring in the immediate postoperative period requiring operative debridement or being delayed after several weeks or months, with a risk of prosthesis contamination. In the case of infection with rigid reconstruction with methylmethacrylate, complete removal of the

Summary

Radical resection of PMST and satisfactory reconstruction of wide sternal defects can be safely performed. Whereas reconstruction after a partial sternectomy is usually done with a PTFE patch and PM transposition with skin advancement, a rigid reinforcement of the sternum can now be achieved with titanium bars and clips after a total sternectomy.

Large sternal defects are safely reconstructed with a musculocutaneous flap, especially in the case of radiation-induced sarcomas. The completeness of

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References (25)

Cited by (18)

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