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Cardiothoracic Surgery |

Sternoclavicular Joint Reconstruction After Resection of Primary Chondrosarcoma

José González García, MD; Sebastian Peñafiel, MD; Eugenia Libreros Niño, MD; Diana Baquero Velandia, MD; Carlos Jordá Aragón, MD; Ángel García Zarza, MD
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La Fe University Hospital, Valencia, Spain


Chest. 2014;145(3_MeetingAbstracts):33A. doi:10.1378/chest.1825095
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Abstract

SESSION TITLE: Surgery Case Report Posters II

SESSION TYPE: Case Report Poster

PRESENTED ON: Sunday, March 23, 2014 at 01:15 PM - 02:15 PM

INTRODUCTION: Chest wall tumors are rarely seen in the manubrium of the sternum. They are usually metastases, but the most common malignant-primary-tumor is chondrosarcoma.

CASE PRESENTATION: 59-year-old male patient had a palpable mass in the manubrium of the sternum, painless and without any other symptoms. CT scan showed a hypo-isointense mass of 90 x 45mm, with no metastases and needle-biopsy confirmed the diagnosis of a primary chondrosarcoma. In a supine position, with a vertical sternum-midline incision, after separating pectoralis major muscles on both sides, a full-thickness resection of the manubrium was performed involving both sternoclavicular joints. The reconstruction was made using an iliac-crest autologous bone graft and three locking-compression-plates (LCP). One 3.5mm curved LCP and one T-shaped-pilon-LCP were used to fix the bone graft to both clavicles and the remaining sternum. Twelve screws were used for the bone graft and remaining parts of the clavicles, and three screws were used for the remaining sternum. An extra 3.5mm reconstruction LCP (130mm, 11 holes) was used. It was fixed at the level of the second ribs with three screws on each side, in order to give strenght to the thoracic cage. No immediate postoperative complications were reported, and the patient was successfully extubated with normal ventilation movements of the thoracic-wall. Follow-up after two years showed no recurrence evaluated with a PET scan, and plates remained in a correct position. The plate used to replace the sternum with the bone graft was surrounded by soft tissue that progressively developed ossifying process. The same happened with the bone graft that merged with the pilon-plate, and the second rib plate merged with the remaining sternum.

DISCUSSION: Sternoclavicular joint compromise raises the difficulty of chest wall constructions. Surgery is the only treatment for this tumors, as there is no effective chemotherapy and chondrosarcomas are relatively radioinsensitive. Four centimeter surgical limits are recommended; this enlarges the size of chest’s area to be taken and complicates its repair.

CONCLUSIONS: Preservation of normal dynamics of respiration and healthy soft tissue coverage of the underlying organs must be the objectives of the surgery. Team work with other speciality colleagues can help us to acquire successful results.

Reference #1: Widhe B, Bauer HC. Surgical treatment is decisive for outcome in chondrosarcoma of the chest wall: a population-based Scandinavian Sarcoma Group study of 106 patients. J Thorac Cardiovasc Surg 2009;137:610-4.

Reference #2: Burt M, Fulton M, Wessner-Dunlap S, Karpeh M, Huvos AG, Bains MS et al. Primary bony and cartilaginous sarcomas of chest wall: results of therapy. Ann Thorac Surg 1992;54:226-32.

Reference #3: Chapelier A. Resection and reconstruction for primary sternal tumors. Thorac Surg Clin 2010;20:529-34.

DISCLOSURE: The following authors have nothing to disclose: José González García, Sebastian Peñafiel, Eugenia Libreros Niño, Diana Baquero Velandia, Carlos Jordá Aragón, Ángel García Zarza

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