2002 CTOS Annual Meeting Oral Presentations — Surgery

APPROACH TO PROSTHETIC RECONSTRUCTION IN STERNAL SARCOMA
[Abstract ID: 40]

Category: Surgery

Presentation: Oral

Authors: Michele Rocca¹, Antonio Briccoli¹

Author Institutions: ¹Department of General Surgery Rizzoli Orthopaedic Institute Bologna, Italy

Presenter: Michele Rocca
michele.rocca@ior.it

Correspondent: Michele Rocca
michele.rocca@ior.it
Bologna Italy 40136
Ph: 390516366222
Fax: 39051331710

Objectives: We performed a retrospective analysis of our experience in chest wall reconstruction after sternectomy for high grade sarcoma. In particular we evaluate a technique of prosthetic reconstruction, where wide resections always including the chest wall are mandatory.

Methods: Sternal and chest wall reconstruction were performed in fifteen patients (7 chondrosarcoma, 2 osteosarcoma, 1 angiosarcoma, 1 Ewing’s sarcoma, 2 radiation-induced sarcoma, 1 liposarcoma, 1 malignant fibrous histiocytoma). After resection of the primary tumor, a tailored Marlex mesh was anchored to the margins of the wall defect. One or two mouldable metallic plates were fixed either to the remaining rib or to the clavicular stumps and to the residual sternum supporting the mesh, avoiding chest wall volet.
Pedicled muscle flaps were always associated to complete reconstruction.

Results: Perioperative mortality was 6.6% (1 case). The mean time of postoperative intubation was 8 hours (range 0-18). During postoperative chemotherapy two patients presented a wound infection, healed after local debridement. The margins achieved by “en bloc” resection of the entire tumor (mean resected skin area 99.7cm2) was wide in 12 patients and marginal in 3 (Enneking’s surgical staging system).
At a mean follow-up of 26.7 months (range 68-12) 13 patients were alive (11 continuously disease free, two alive with distant metastases or local relapse); two patients died. All patients recovered their normal lifestyle.

Conclusions: The authors believe that the reconstruction technique adopted is feasible and favorable due to its short hospitalization, good local control, and because it prevents prolonged post-operative mechanical ventilation and future restriction-related working incapacity.