A strategy for near normal reconstruction of sternum

Abstract

Objective

Sternal tumour, though an extremely rare entity in clinical practice, constitutes a great therapeutic challenge in view of its critical domain and function in thoracic cage. Neoplasm of sternum necessitates subtotal/total sternectomy that in turn mandates secure and concrete reconstruction to protect important thoracic organs and provide optimal cardio-respiratory function.

Methods

This report is based on retrospective study of three patients with sternal tumours for whom Senior Author performed subtotal sternal resection and reconstruction over a period from 2010 to 2012. A 29-year-old male presented with osteoclastoma of the manubrium and upper sternum and the other two with metachronal sternal metastasis from chondrosarcoma from the lower limb and carcinoma breast. Methyl methacrylate powder was initially mixed with sterile water to make into paste and then allowed to solidify exactly in the shape of excised sternum with or without costal cartilage and ribs. The rigid cast was then fitted into the gap and appropriately fixed which was reinforced with myocutaneous flap for cover using bilateral pectoralis major muscles.

Results

All three patients made satisfactory recovery with stable chest wall, normal cardio-respiratory function and satisfactory cosmesis. Patients were followed up after 3 weeks with clinical assessment and X-ray at 6 months and yearly thereafter. Follow-up ranged from 2 to 4 years with patients enjoying good quality of life. Secure repair was confirmed clinically and by CT scan (computed tomography) study performed at least once between 6 months to 1 year.

Conclusion

Our standardized technique of reconstruction of sternum using polymethyl methacrylate implant prepared exactly in the shape of excised sternum and costal cartilages/ ribs reinforced with pectoralis major myocutaneous flap yielded excellent results at medium-term follow-up.