Abstract Introduction Primary sternal tumors account for 1% of primary bone tumors. Chondrosarcoma is a type of malignant bone tumor that arises from cartilage cells. The most commonly affected sites are the pelvis, femur and shoulder. Sternal chondrosarcomas are difficult to treat as chemotherapy and radiation options are limited. Surgical resection with reconstruction can be difficult due to large bone and soft tissue defects. Inadequate resection and reconstruction can result in deformity and paradoxical chest wall movements. Case Report This case presentation is a 46-year-old woman underwent radiography which incidentally revealed lytic lesion in the sternum concerning for malignancy with biopsy confirming grade 1 chondrosarcoma. She underwent surgical resection with reconstruction using polypropylene mesh and methylmethacrylate mixed with tobramycin to create a methylmethacrylate patch. The defect measured 9 x 10 cm. Polypropylene sutures were placed circumferentially through the sternum, manubrium, and bilateral costal cartilages for planned mesh placement. Using a polypropylene mesh and methylmethacrylate mixed with tobramycin, a methylmethacrylate patch was created to fit the defect. Previously placed sutures were brought through the patch circumferentially and then tied down to secure the methylmethacrylate patch. The second and third intercostal cartilages were bridged with resorbable rib plates and secured with polypropylene sutures to provide additional stability to the chest wall and patch. Complete coverage of the mesh was achieved with bilateral pectoralis major muscle advancement flaps, performed by the plastic surgery team. One drain was placed over the methylmethacrylate patch alongside two subcutaneous drains. The patient tolerated the procedure well. She was discharged on postoperative day six with no complications, sternal complaints or recurrence at her most recent 6-month follow-up appointment. Discussion of novelty and importance of case This case is notable because chondrosarcomas of the sternum are exceedingly rare with only a few reconstruction techniques discussed in the literature. Methylmethacrylate patches provide a rigid framework to protect the heart and great vessels and help prevent paradoxical chest wall movements. It is preferred over biological or tissue-only repairs due to its strong mechanical support and ability to be molded intraoperatively to fit irregularly shaped defects. Sharing the details of the case and positive outcomes will add to the very small body of knowledge regarding how to surgically manage these unique lesions. This abstract is funded by: None
Pandey et al. (Fri,) studied this question.