Optimizing Reconstruction of Oncologic Sternectomy Defects Based on Surgical Outcomes

Abstract

Background The optimal strategy for oncologic sternectomy reconstruction has not been well characterized. We hypothesized that the major factors driving the reconstructive strategy for oncologic sternectomy include the need for skin replacement, extent of the bony sternectomy defect, and status of the internal mammary vessels. Study Design We reviewed consecutive oncologic sternectomy reconstructions performed at The University of Texas MD Anderson Cancer Center over a 10-year period. Regression models analyzed associations between patient, defect, and treatment factors and outcomes in order to identify patient and treatment selection criteria. We developed a generalized management algorithm based on these data. Results Forty-nine consecutive patients underwent oncologic sternectomy reconstruction (mean follow-up = 18±23 months). More sternectomies were partial (74%) rather than total/sub-total (26%). Most defects (N=40, 82%) required skeletal reconstruction. Pectoralis muscle flaps were most commonly employed for sternectomies with intact overlying skin (64%) and infrequently used when a presternal skin defect was present (36%; p=0.06). Free flaps were more often used for total/sub-total versus partial sternectomy defects (75% vs. 25%, respectively; p=0.02). Complication rates for total/sub-total sternectomy and partial sternectomy were equivalent (46% vs. 44%, respectively; p=0.92). Conclusions Despite more extensive sternal resections, total/sub-total sternectomies resulted in equivalent postoperative complications when combined with the appropriate soft tissue reconstruction. Good surgical and oncologic outcomes can be achieved with defect-characteristic-matched reconstructive strategies for these complex oncologic sternectomy resections.

Short and long-term results of sternectomy for sternal tumours

“…In the large populationbased study of Scandinavian Sarcoma Group, is clearly demonstrated the influence of wide free margins on survival; patients radically treated have higher probability of survival at 10 years (92%) compared with intralesional resections (13). Also others authors previously showed a better outcome in term of OS for patients surgically treated without margin involvement (1,19,22). In our report, the DFS is negatively influenced by margins; actually patients with incomplete resection developed early local or distant recurrence.…”

Sternectomy for Treating Advanced Non-Melanoma Skin Cancer

“…Sternum resection for treatment of skin cancer is very rare. With a series of 49 cases, Butterworth et al [1] reported that the main cause of sternectomy was involvement of sternum metastatic tumors and, secondly, sarcomas. No case with skin tumors was described among the patients, who were mostly females.…”

“…The sternum is an unusual anatomical site for cancers, making sternectomy for oncologic resections rare [1]. The main indication of sternectomy is surgical treatment of infectious complications after cardiovascular and thoracic surgery, which involves a transsternal approach.…”

Porous alumina ceramic sternum: A reliable option for sternal replacement

“…We propose a new material for thoracic wall reconstruction and particularly for sternum. Several drawbacks have been reported for biomaterials used in chest wall reconstruction over the past 30 years:[ 2 ] erosion of adjacent structures, rupture and migration, infection, or immunological reaction. During the past 5 years, custom-made titanium sternal implants, sternal allografts, and mesh have been associated with advantages over other materials.…”