Resection and Reconstruction for Primary Sternal Tumors
Section snippets
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
References (25)
- et al.
Predictors of survival in malignant tumors of the sternum
J Thorac Cardiovasc Surg
(1996) - et al.
Sternal resection for primary or secondary tumors
J Thorac Cardiovasc Surg
(1997) - et al.
Sternal resection and reconstruction for primary tumors
Ann Thorac Surg
(2004) - et al.
Medical tumors of the chest wall. Solitary plasmacytoma and Ewing’s sarcoma
J Thorac Cardiovasc Surg
(1993) - et al.
Hemangioma of the sternum
Ann Thorac Surg
(2008) - et al.
Primary chest wall tumors: factors affecting survival
Ann Thorac Surg
(1986) Use of prosthetic materials in chest-wall reconstruction
Surg Clin North Am
(1989)- et al.
Early and long-term results of prosthetic chest wall reconstruction
J Thorac Cardiovasc Surg
(1999) - et al.
Functional assessment of chest wall integrity after methylmethacrylate reconstruction
Ann Thorac Surg
(2000) - et al.
Results of chest wall resection and reconstruction with and without rigid prosthesis
Ann Thorac Surg
(2006)
A novel titanium rib bridge system for chest wall reconstruction
Ann Thorac Surg
Use of moldable titanium bars and rib clips for total sternal replacement: a new composite technique
J Thorac Cardiovasc Surg
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Manubrioclavicular and manubriosternal reconstruction after radical resection for chondrosarcoma of manubriosternum: A modified surgical technique
2015, Annals of Thoracic SurgeryCitation Excerpt :All kinds of materials have been used for reconstruction of chest wall defects (eg, polytetrafluorethylene patch, titanium plates, stainless steel mesh, resin plates, bone grafts, and STRATOS osteosynthetic system). With recent advances, a cryopreserved sternochondral allograft has been successfully implanted [7]. Methyl methacrylate cement sandwiched in Marlex mesh molded according to the geometry of the chest wall is one of the best materials to provide optimal reconstruction with maximal stability.
Autogenous rib grafts for reconstruction of the manubrium after resection: Technical refinements and outcomes
2014, Journal of Thoracic and Cardiovascular SurgerySternal resection and reconstruction: a review
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