Joel Raj Kumar, Benjamin Santhosh Regini, Rao Vinay Murahari, Kodiatte Thomas Alex, Gnanamuthu Birla Roy, Mohammad Aamir, Sameer Mallampati, David Nishok
The Department of Cardiothoracic Surgery, The Christian Medical College, Vellore, Tamil Nadu 632004 India.
The Department of Pathology, The Christian Medical College, Vellore, Tamil Nadu 632004 India.
Indian J Thorac Cardiovasc Surg. 2024 Mar;40(2):184-190. doi: 10.1007/s12055-023-01583-8. Epub 2023 Aug 25.
Tumours of the sternum can be either primary or secondary with malignancy being the most common etiology. Wide local excision of these tumours results in a midline defect which pose a unique challenge for reconstruction. As limited data on the management of these tumours exists in the literature, we hereby report 14 consecutive patients who were treated at our institute between January 2009 to December 2020. Most of them were malignant with majority of them, 11 (78%) patients, with manubrial involvement requiring partial sternectomy. Overall, the average defect size was 75 cm. Reconstruction of the chest wall defect was done using a semi-rigid fixation: mesh and suture stabilization in 3 (21%) or suture stabilization in 7 (50%) and without mesh or suture stabilization in 3 (21%) patients. Rigid fixation with polymethyl methacrylate (PMMA) was done for one patient (7%). Pectoralis major advancement flap was most commonly used for soft tissue reconstruction with flap necrosis noted in one patient (7%). There was no peri-operative mortality and one patient required prolonged post-operative ventilation. On a median follow-up of 37.5 months, one patient (7%) had a recurrence. Sternal defects after surgical resection reconstructed with semi-rigid fixation and suture stabilization render acceptable post-operative outcomes.
胸骨肿瘤可以是原发性或继发性的,恶性肿瘤是最常见的病因。对这些肿瘤进行广泛的局部切除会导致中线缺损,这给重建带来了独特的挑战。由于文献中关于这些肿瘤治疗的资料有限,我们在此报告2009年1月至2020年12月期间在我们研究所接受治疗的14例连续患者。其中大多数为恶性肿瘤,其中11例(78%)患者累及胸骨柄,需要进行部分胸骨切除术。总体而言,平均缺损大小为75平方厘米。胸壁缺损的重建采用半刚性固定:3例(21%)患者采用网片和缝线固定,7例(50%)患者采用缝线固定,3例(21%)患者未采用网片或缝线固定。1例(7%)患者采用聚甲基丙烯酸甲酯(PMMA)进行刚性固定。胸大肌推进皮瓣最常用于软组织重建,1例(7%)患者出现皮瓣坏死。无围手术期死亡病例,1例患者术后需要长时间通气。中位随访37.5个月时,1例(7%)患者复发。采用半刚性固定和缝线固定重建手术切除后的胸骨缺损可获得可接受的术后效果。