Reconstruction of the Chest Wall following Sternal Tumor Excision

Dr Budhi Nath Adhikari Click to edit Master subtitle style M Ch Resident, TUTH Plastic Surgery

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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 2/14/13

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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)
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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 2/14/13 plasmacytomas to r/o

Discussion

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Goal of treatment
Reconstruction that allows
1.

a return to acceptable respiratory parameters, the control of wounds, and elimination of the need for respiratory support measures. Ablation, cure and treatment of the primary disease process

2. 3.

4.

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Options for Skeletal reconstruction

Ribs Fascia lata Steel/Prolene wiring Prolene mesh Gore-tex mesh Methacrylate sandwitch Commercial systems
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Soft tissue coverage

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

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C A

B A

B D

A. B. C.

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D. E.

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

Pectoralis Major muscle flap

Dual blood supply Versatile flap with great utility

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Thank You
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