Hann Miranda C, Pettiford Brian, Babycos Christopher
The University of Queensland School of Medicine, Ochsner Clinical School, New Orleans, LA.
Department of Thoracic Surgery, Ochsner Clinic Foundation, New Orleans, LA.
Ochsner J. 2018 Summer;18(2):180-182. doi: 10.31486/toj.17.0066.
Chondrosarcoma, the most common primary malignant tumor of the chest wall, most frequently arises from the sternum, with limited reported cases of tumor origination from the xiphoid process. Because of the location, patients present with complaints of a large chest wall mass associated with pain and respiratory symptoms. These tumors are best managed by en bloc resection and chest wall reconstruction.
A 49-year-old male nonsmoker with a strong family history of colon cancer presented with a large, painful chest wall mass associated with shortness of breath and exertional chest pressure. Computed tomography scan demonstrated a large mass arising from the xiphoid process; biopsy confirmed a grade 1 chondrosarcoma. The mass was removed en bloc and repaired with an innovative technique using omentum and PROCEED Surgical Mesh (Ethicon US, LLC). The wound was closed with a fasciocutaneous flap.
To our knowledge, this case is the first report of a chest wall reconstruction of a large inferior sternal defect using only polypropylene and omentum without a rigid support or muscular flap. This repair option could be considered for patients in whom traditional rigid repair methods have potential complications or limitations.
软骨肉瘤是胸壁最常见的原发性恶性肿瘤，最常起源于胸骨，源于剑突的肿瘤病例报道有限。由于其位置，患者表现为伴有疼痛和呼吸症状的巨大胸壁肿块。这些肿瘤最好通过整块切除和胸壁重建来治疗。
一名49岁的男性非吸烟者，有结肠癌家族史，因伴有呼吸急促和运动时胸部压迫感的巨大、疼痛性胸壁肿块前来就诊。计算机断层扫描显示一个源于剑突的巨大肿块；活检证实为1级软骨肉瘤。该肿块被整块切除，并采用一种使用大网膜和PROCEED外科补片（美国强生公司Ethicon）的创新技术进行修复。伤口用筋膜皮瓣闭合。
据我们所知，本病例是首例仅使用聚丙烯和大网膜而无刚性支撑或肌瓣修复巨大胸骨下缺损胸壁的报告。对于传统刚性修复方法有潜在并发症或局限性的患者，可以考虑这种修复选择。
