Chest Wall Reconstruction and Advanced Disease

Beahm, Elisabeth K.; Chang, David W.

doi:10.1055/s-2004-829046

Cited by 22 publications

(27 citation statements)

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“…This tumour appears as a radiolucent mass originating from the medullary region of the bone and is usually associated with cortical destruction and stippled calcification. Surgery in the form of radical en bloc excision and immediate reconstruction is the key to the management of primary sarcomas of the sternum [2][3][4][5][6][7]. Surgery alone is potentially curative in a majority of the cases, with the 10-year survival rate approaching 97 %.…”

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confidence: 99%

“…Sternal resection can potentially result in large defects requiring complex reconstructions and various reconstruction techniques using prosthetic or homologous materials that have been described [2][3][4][5][6][7]. Skeletal reconstruction is considered not necessary for defects <5 cm in diameter.…”

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confidence: 99%

“…Chest wall stability is generally achieved by reconstruction of skeletal defect with synthetic meshes such as polypropylene or polytetrafluoroethylene (Marlex) with or without methyl methacrylate reinforcement. The other options include the titanium meshes and metallic implants and the use of allografts [4][5][6]. A double-layer polypropylene mesh with methyl methacrylate reinforcement was used to achieve chest wall stability in our patient [4].…”

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“…An extensive full thickness resection generally precludes a primary closure; regional myocutaneous flaps like the lattissimus dorsi, rectus abdominis, pectoralis major, external oblique and omental flaps have been used to achieve a skin and soft tissue cover [5,6].…”

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“…The thoracodorsal vessel-based latissimus dorsi flap, more commonly used for breast reconstruction, is also used in chest wall reconstructions [5,6]. The potential advantages of the flap include its straightforward harvest, robust vascularity and an easy arc of rotation.…”

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A Novel Clinical Application of the Classical Bakamjian Flap in the Reconstruction of a Sternal Chondrosarcoma Defect

Krishnamurthy

2014

Indian J Surg

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The deltopectoral flap also called the Bakamjian flap was originally described as a two-stage procedure for p h a r y g o e s o p h a g e a l r e c o n s t r u c t i o n f o l l o w i n g laryngopharyngectomy. It became the "workhorse" flap for head and neck reconstruction in the 1960s, but its popularity gradually faded with the introduction of pedicled myocutaneous flaps and subsequently microvascular free flaps. However, the technical simplicity of raising the Bakamjian flap along with its predictable vascular supply has ensured that the flap continues to remain as a time-tested salvage option in head and neck reconstruction. The use of this flap for sternal reconstruction, to the best of our knowledge, has not been described before. We present a rare case of a primary sternal chondrosarcoma and discuss its management challenges and also present, possibly for the first time, a novel application for the well-described Bakamjian flap in this setting as a single-stage procedure. Keywords Deltopectoral flap . Bakamjian flap . Sternal chondrosarcoma . Sternal reconstructionChondrosarcomas are a heterogeneous group of malignant mesenchymal tumours derived from a cartilaginous origin. These tumours are generally known to involve the pelvis and the long bones. They account for about 20 % of the primary tumours of the chest wall, of which 20 % are believed to arise from the sternum [1]. Although chondrosarcoma is a commonly described malignant tumour of the chest wall and sternum, its relative occurrence is rare. We present a case of a primary sternal chondrosarcoma and discuss its management challenges and also present, possibly for the first time, a novel application for the well-described Bakamjian flap in this setting.A 68-year-old male without any comorbid illness was referred to our centre for evaluation of a progressively enlarging swelling of his anterior chest wall for over a year. Clinical examination revealed a mildly tender, well circumscribed, 5×4-cm bony swelling in relation to the middle third of the sternum, 3 cm below the sternal notch. There was no significant axillary adenopathy. A chest X-ray and a subsequent computerised tomography of the chest revealed a 5×4×7-cm expansile lytic lesion involving the middle third of the sternum and the adjoining left fourth and fifth costochondral junctions with a large soft tissue component on either sides of the sternum, reaching up to the pericardium posteriorly and up to the skin anteriorly. The pulmonary parenchyma was however normal (Fig. 1a). A bone scan revealed an isolated hot spot in the sternum corresponding to the lytic lesion, as visualised on the CT scan (Fig. 1b). A trucut biopsy from the mass lesion revealed a tumour composed of lobules of atypical cartilage cells, suggesting a diagnosis of chondrosarcoma grade I. A radical en bloc resection of the sternal lesion preserving the manubrium and the xiphoid was subsequently performed; which resulted in a large full thickness skin, soft tissue and bony defect (Fig. 2a, b). The resultant bony de...

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