Chondrosarcoma from the sternum: Reconstruction with titanium mesh and a transverse rectus abdominis myocutaneous flap after subtotal sternal excision

Koto, Kazutaka; Sakabe, Tomoya; Horie, Naoyuki; Ryu, Kazuteru; Murata, Hiroaki; Nakamura, Shinichiro; Ishida, Toshihiro; Konishi, Eiichi; Kubo, Toshikazu

doi:10.12659/msm.883471

Cited by 15 publications

(14 citation statements)

References 24 publications

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“…The choice of reconstruction technique depends on the extent and localization of the defect using various prosthetic and homologous materials, including synthetic and metallic grafts, pedicled skin and muscle fl aps, free skin grafts, fascia lata and autologous bone transplants [10].…”

Section: Case Reportmentioning

confidence: 99%

Titanium Mesh Reconstruction after Solitary Sternal Plasmacytoma Surgery-A Case report

Krdzalic¹

2017

Int J Immunother Cancer Res

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Section: Case Reportmentioning

confidence: 99%

Titanium Mesh Reconstruction after Solitary Sternal Plasmacytoma Surgery-A Case report

Krdzalic¹

2017

Int J Immunother Cancer Res

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“…However, there is figurative literature about reconstruction methods after sternum resection. Some artificial materials, such as organic glass plate, steel plate, titanium mesh, and autologous tissue (autologous bone and muscle flap) were used as alternative material, [2][3][4][5] each has advantages and disadvantages. In this study, 3 patients underwent sternum resection and reconstruction using allogeneic graft, which produced satisfactory clinical results.…”

Section: Introductionmentioning

confidence: 99%

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Zhao

Peng²,

Liu³

et al. 2016

Exp Clin Transplant

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Objectives: This paper aimed to study the feasibility, the surgical methodology, and technique for reconstruction using allogeneic sternal graft after sternum tumor resection. Materials and Methods: Three patients (2 men and 1 woman, aged 19, 44, and 52) with primary sternum malignant tumor were admitted from January 2008 to December 2010 to the Second Hospital of Shandong University, Jinan, China. We conducted subtotal resection of the sternum and simultaneous reconstruction with allogeneic sternal graft. Allogeneic sternum was frozen beforehand; the scope of removal was 2 cm away from the lesion. Transplanted allogeneic sternum was fixed using steel wire and residual cavity was filled with the greater omentum. Results: Three patients recovered without major complication and were discharged from the hospital with successful operation and satisfactory results. They were followed-up for 6 months to 2 years, no tumor relapse or any obvious rejection were found. Conclusions: The freezing allogeneic sternum can be used as a substitute for reconstruction after sternum tumor resection.

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“…This tumour appears as a radiolucent mass originating from the medullary region of the bone and is usually associated with cortical destruction and stippled calcification. Surgery in the form of radical en bloc excision and immediate reconstruction is the key to the management of primary sarcomas of the sternum [2][3][4][5][6][7]. Surgery alone is potentially curative in a majority of the cases, with the 10-year survival rate approaching 97 %.…”

mentioning

confidence: 99%

“…Sternal resection can potentially result in large defects requiring complex reconstructions and various reconstruction techniques using prosthetic or homologous materials that have been described [2][3][4][5][6][7]. Skeletal reconstruction is considered not necessary for defects <5 cm in diameter.…”

mentioning

confidence: 99%

“…The disadvantages of this flap include the need to reposition the patient to a lateral decubitus position for flap harvest and the possibility of functional shoulder morbidity. The rectus abdominus myocutaneous flap and its variations based on the deep inferior and superior epigastric arteries, popularly used in breast reconstruction, are additional options for sternal reconstruction considering its ease of harvest, reliability and the large amount of tissue that can be harvested and still permitting a primary closure of the donor site [3,6,7]. The limitations to the use of the rectus abdominis myocutaneous flaps are mainly related to donor site concerns which include decreased abdominal strength and reported increased risk of herniation.…”

mentioning

confidence: 99%

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A Novel Clinical Application of the Classical Bakamjian Flap in the Reconstruction of a Sternal Chondrosarcoma Defect

Krishnamurthy

2014

Indian J Surg

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The deltopectoral flap also called the Bakamjian flap was originally described as a two-stage procedure for p h a r y g o e s o p h a g e a l r e c o n s t r u c t i o n f o l l o w i n g laryngopharyngectomy. It became the "workhorse" flap for head and neck reconstruction in the 1960s, but its popularity gradually faded with the introduction of pedicled myocutaneous flaps and subsequently microvascular free flaps. However, the technical simplicity of raising the Bakamjian flap along with its predictable vascular supply has ensured that the flap continues to remain as a time-tested salvage option in head and neck reconstruction. The use of this flap for sternal reconstruction, to the best of our knowledge, has not been described before. We present a rare case of a primary sternal chondrosarcoma and discuss its management challenges and also present, possibly for the first time, a novel application for the well-described Bakamjian flap in this setting as a single-stage procedure. Keywords Deltopectoral flap . Bakamjian flap . Sternal chondrosarcoma . Sternal reconstructionChondrosarcomas are a heterogeneous group of malignant mesenchymal tumours derived from a cartilaginous origin. These tumours are generally known to involve the pelvis and the long bones. They account for about 20 % of the primary tumours of the chest wall, of which 20 % are believed to arise from the sternum [1]. Although chondrosarcoma is a commonly described malignant tumour of the chest wall and sternum, its relative occurrence is rare. We present a case of a primary sternal chondrosarcoma and discuss its management challenges and also present, possibly for the first time, a novel application for the well-described Bakamjian flap in this setting.A 68-year-old male without any comorbid illness was referred to our centre for evaluation of a progressively enlarging swelling of his anterior chest wall for over a year. Clinical examination revealed a mildly tender, well circumscribed, 5×4-cm bony swelling in relation to the middle third of the sternum, 3 cm below the sternal notch. There was no significant axillary adenopathy. A chest X-ray and a subsequent computerised tomography of the chest revealed a 5×4×7-cm expansile lytic lesion involving the middle third of the sternum and the adjoining left fourth and fifth costochondral junctions with a large soft tissue component on either sides of the sternum, reaching up to the pericardium posteriorly and up to the skin anteriorly. The pulmonary parenchyma was however normal (Fig. 1a). A bone scan revealed an isolated hot spot in the sternum corresponding to the lytic lesion, as visualised on the CT scan (Fig. 1b). A trucut biopsy from the mass lesion revealed a tumour composed of lobules of atypical cartilage cells, suggesting a diagnosis of chondrosarcoma grade I. A radical en bloc resection of the sternal lesion preserving the manubrium and the xiphoid was subsequently performed; which resulted in a large full thickness skin, soft tissue and bony defect (Fig. 2a, b). The resultant bony de...

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Chondrosarcoma from the sternum: Reconstruction with titanium mesh and a transverse rectus abdominis myocutaneous flap after subtotal sternal excision

Cited by 15 publications

References 24 publications

Titanium Mesh Reconstruction after Solitary Sternal Plasmacytoma Surgery-A Case report

Titanium Mesh Reconstruction after Solitary Sternal Plasmacytoma Surgery-A Case report

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A Novel Clinical Application of the Classical Bakamjian Flap in the Reconstruction of a Sternal Chondrosarcoma Defect

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