Sakamoto Akio, Tsuge Itaru, Noguchi Takashi, Matsuda Shuichi
The Department of Orthopaedic Surgery, Graduate School of Medicine, Kyoto University, Kyoto, Japan.
Department of Plastic and Reconstructive Surgery, Graduate School of Medicine, Kyoto University, Kyoto, Japan.
J Surg Case Rep. 2021 Oct 28;2021(10):rjab450. doi: 10.1093/jscr/rjab450. eCollection 2021 Oct.
Following resection of a sternal tumor, respiratory dysfunction can occur and rigid reconstruction is necessary. An 82-year-old woman noted a mass in the anterior chest wall that was increasing in size. The tumor was located on the left aspect of the sternum at the level of the third rib. A radiation-induced malignant spindle cell tumor was diagnosed because of a history of irradiation for hilar lymph node carcinoma. The tumor was resected with the surrounding tissues of the second-to-fourth ribs and sternum. The posterior sternal cortex was preserved by cutting with a curved chisel under fluoroscopy. The chest wall defect was reconstructed with a 2-mm thick Gore-Tex® sheet and a local transpositional flap. Sternal resection with a chisel under fluoroscopy avoids damage to the internal thoracic artery. Preserving the posterior sternal cortex does not require rigid reconstruction. The procedure is minimally invasive.
切除胸骨肿瘤后，可能会出现呼吸功能障碍，因此需要进行坚固的重建。一名82岁女性发现前胸壁有一肿物，且肿物大小不断增大。肿瘤位于胸骨左侧第三肋骨水平。由于曾因肺门淋巴结癌接受过放疗，诊断为放射性诱发的恶性梭形细胞瘤。肿瘤连同第二至第四肋骨及胸骨的周围组织一并切除。在荧光镜引导下用弯凿切割，保留胸骨后皮质。胸壁缺损用2毫米厚的戈尔特斯（Gore-Tex®）补片和局部转位皮瓣进行重建。荧光镜引导下用凿子进行胸骨切除可避免损伤胸廓内动脉。保留胸骨后皮质无需进行坚固的重建。该手术微创。
