Rare tumour of sternum: Resection & reconstruction

A 53 yr old male† presented to the Surgical Oncology department of Saifee Hospital, Mumbai, India, in July 2019, with a sternal abscess and no overlying skin lesion. He was diagnosed to have squamous cell carcinoma on biopsy. Positron-emission tomography (PET) scan showed no other sites of disease.

Surgery entailed en bloc removal of the manubrium with bilateral first and second costochondral junctions and medial ends of both clavicles (Fig. 1). Reconstruction was done with titanium mesh fixed with steel wires and pectoralis major myocutaneous flap cover (Figs 2-4). Final histopathology showed moderately differentiated squamous cell carcinoma involving the bone and overlying muscle with only fibrosis of the epidermis and dermis. Resected margins were free. The patient underwent radiation thereafter and was doing well post-operatively.

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Fig. 1 Defect post-tumour resection (black arrow - left lung apex, red arrow - cut end of right sternoclavicular joint, green arrow - cut end of right rib, yellow arrow - arch of aorta, blue arrow - right brachiocephalic vein).

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Fig. 2 Titanium mesh cut to the defect size (the notches in the upper two corners are to fit the cut edges of sternoclavicular joints).

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Fig. 3 Pectoralis flap rotated to cover the titanium mesh (red arrow - flap, black arrow - underlying mesh).

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Fig. 4 Final wound post-skin closure.

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