Porous Ceramic Sternal Prosthesis Implantation in a 13-Year-Old Patient Presenting with Metastatic Ewing's Sarcoma

Abstract

Ewing's sarcoma is the second most frequent primary malignant bone tumor in adolescents and young adults. Locations on the thoracic wall represent up to 20% of primary and secondary locations. We present the case of a 13-year-old patient treated with the use of a radiolucency porous bioceramic prosthesis as a sternal replacement for a wide tumor resection in an oncologic context. Focal radiation therapy was not possible due to the high risk of severe myocardial injuries caused by the sternal location of the tumor. The sternum CERAMIL® (I.CERAM, Limoges, France), in porous alumina (Al2O3) has already been implanted into adults in sternal replacement during its invasion by a tumor or its infectious destruction. There were no complication concerning the surgery. The last follow-up at 2 years postoperatively reveals a satisfactory clinical situation with any functional thoracic complaint and nor any functional respiratory symptoms. The porous alumina sternal prosthesis offers a reliable alternative for sternal replacement indications for children in an oncologic context.

Sternal resection and reconstruction: a review

“…From these first prostheses many other different techniques have been proposed for rigid chest wall reconstruction with variable results such as the use of other mesh-bone cement sandwiches ( 66 ), Kirschner wires ( 67 ), steel sutures ( 68 ), ceratite prosthesis ( 69 ), porous alumina ( 70 ), Ley prosthesis ( 71 ), rib-like technique ( 72 ) or customized sternal plates ( 73 , 74 ) but titanium-based devices are by far the most commonly used nowadays. They have clear advantages over other systems (biocompatibility, osseointegration, resistance to infection, a high strength/weight ratio and low optical density), although they are not free of complications similar to other devices such as rupture, displacement, thoracic pain or infection ( 47 , 50 ).…”