Reconstruction of the Chest Wall following Sternal Tumor Excision

Dr Budhi Nath AdhikariM Ch Resident, TUTH

Plastic Surgery

Our Patient

• 63 years old, Male• Slow growing sternal mass without skin

changes 1 year• No chest symptoms or bone pain• Smoker, alcohol consumer• HTN 10 years on medication• Similar firm swelling scapular region• Biopsy = low grade spindle cell sarcoma

Hospital course

• Air Leak on day 1 – Opsite dressing done• Rt chest tube removed on day 6, left on day 7.

S/C drain on day 6• Normal chest expansion on post operative

Chest X ray• Minimal soakage from upper chest suture site

(?pericardial fluid)

Final HPE report

• Plasma cell neoplasm involving the sternal marrow. All resection margins and skin free of tumor.

• Further confirmation awaited• Similar diagnosis on the scapular mass

• Multiple solitary plasmacytomas to r/o Multiple Myeloma

Discussion

Goal of treatment

Reconstruction that allows1. a return to acceptable respiratory

parameters, 2. the control of wounds, and 3. elimination of the need for respiratory

support measures. 4. Ablation, cure and treatment of the primary

disease process

Options for Skeletal reconstruction

• Ribs• Fascia lata• Steel/Prolene wiring• Prolene mesh • Gore-tex mesh• Methacrylate sandwitch• Commercial systems

Soft tissue coverage

• Pectoralis Muscle• Latissmus Dorsi• TRAM flap• Serratus anterior muscle flap• Omental flap• External Oblique• Trapezius• Thoracoepigastric Flaps

• Free Flaps ± vein graft/loop

A. Pectoralis mayor m. flap – thoracoacromial a.B. Latissimus dorsi m. flap – thoracodorsal a.C. Serratus anterior m. flap – thoracodorsal a. (br)D. Greater omentum flap – r or l gastroepiploic a.E. Rectus abdominis m. flap - sup. Epigastric a.

B

C

D

A

EA

B

C

Pectoralis Major muscle flap• Dual blood supply• Versatile flap with great utility

A

X

Thank You