Medicina Pulmonar e Respiratória

Interest of Myocutaneous Plasty after Extended Sternal Resection

Abstract

Ahmed Ben Ayed, Abdessalem Hentati, Walid Abid, Iyadh Ghorbel, Khalil Nouri

Background: Thoracic wall reconstruction is commonly performed by using muscle flaps or prosthetic materials. We try through this article to show the possibility of myoplasty in extended thoracic wall resections.
Case report: A 33-year-old woman had been treated by chemo-radiotherapy, for undifferentiated carcinoma of the nasopharyngeal type. The CT-scan completed by magnetic resonance showed a 10 cm sternal mass centered by the manubriosternal articulation with an infiltration of left and right second sternocostal joints and intercostal muscles. The diagnosis of a single sternal metastasis of nasopharyngeal carcinoma was established.

After the resection of anterior arc of right ribs (from the first to the third), resection of internal right clavicle edge, transverse sternotomy above xiphoid process, resection of anterior arc of left ribs (from the first to the third), resection of internal left clavicle edge, sternal tumor and sternal body were removed en-bloc without a 2 cm residual extension which was marked by metallic clips. A myocutaneous plasty using pectoralis major and pectoralis minor muscles covered the chest wall defect after the release of the pectoralis major from its humeral attachment.

The postoperative course was uneventful. Residual tumor was treated by radiotherapy with no disease recurrence sign for 3 years later.
Conclusion: The choice of muscle to use depends on the location and the extent of the defect to be repaired. The knowledge of the anatomy of the muscles is essential to obtain a good quality flap.