Chondrosarcoma of the sternum. Sternum resection and the plasty of the defect with the titanium mesh. The case report
Chondrosarcoma of the sternum is a rare tumor. Chemotherapy and radiation are not effective in the treatment of these tumors. The only effective treatment is the surgical resection with the wide clear margin. The surgical excision of the sternal tumor results in a large defect of tissue and can lead to instability of the chest wall. This defect must be reconstructed to prevent the violation of the lung function. The skeletal defects with a diameter less than 5 cm can be not reconstructed. The bigger defects must be reconstructed immediately. There are many methods of the reconstruction of the sternum defect. The musculocutaneous flaps, autologous bone transplants, or the alloplastic materials, can be used. There is no ideal prosthetic material. Whereas titanium mash alone or in combination with other materials is the most used. One of the proposed material to restore the defect is the cryopreserved sternum, but the authors prove that this method needs validation. 74-year-old patient diagnosed with the chondrosarcoma of the sternum was admitted to the department of the thoracic surgery of the Lviv regional oncological center. The diagnosis was established by chest computed tomography and the biopsy. Two and half years ago patient underwent the sternotomy during the aortocoronary bypass graft surgery. The tumor in the sternum was detected a half of the year ago, but it was considered as the local osteomyelitis. The treatment was ineffective. After biopsy, the diagnosis of chondrosarcoma was established. After the certain therapy the patient was operated. The wide resection of the body of the sternum was performed. During the procedure, the right pleural cavity was opened. The skeleton defect was repaired using two prosthetic materials. The polypropylene mesh was used as the first layer to protect the heart. It was fixed by the non-absorbable sutures to the wound margin. Upper the polypropylene, the titanium mesh was placed and fixed by the steel sutures to the ribs and the rest of the sternum. The right pleural cavity and the retrosternal space were drained. The pleural drainage tube was eliminated on day 4 after the chest radiology examination. The mediastinal drainage tube was settled on active aspiration and was left until the fluid stopped flowing. It was eliminated on day 16 after surgery. The pain was treated by the non-steroidal analgesics. The patient was discarded one month after the surgery. The control 2 months after surgery showed no pathological signs. The pain disappeared, the physical activity was restored. The surgical treatment of the sternal chondrosarcoma has dual aim. The first one is the adequate resection of the tumor to achieve the clear margin, and the second is the plasty of the tissue defect. To reconstruct a large defect, various surgical techniques and materials can be used. The surgeon must plan the intervention and foresee the difficulties. The type of plastic material can depend of the size of the defect. The surgeon must pay a lot of attention to prevent the infection, which can lead to the rejection of the prosthesis. This can be achieved by the firm fixation of the prosthesis, adequate drainage of the operation field and the antibiotic prophylaxis. Proper analgesic administration, physical exercises, as soon as possible, can accelerate the patient’s recovery.
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