A Resection of the Giant First Left Rib Tumor and Chest Wall Reconstruction by Transmanubrial Osteomuscular Sparing Approach

Takanori Ayabe, Masaki Tomita, Hiroki Mori, Eiichi Chosa, Kunihide Nakamura

Division of Thoracic and Breast Surgery, Department of Surgery, Faculty of Medicine, University of Miyazaki, Miyazaki, Japan.

DOI: 10.4236/ojts.2015.53008                

Abstract

A 64-year-old female had noticed an 11 × 6 cm mass growing on her left first rib. We performed a resection of the first and second ribs and a reconstruction of the chest wall. A thoracotomy was performed at the anterolateral second intercostal space. The second rib cartilage was divided at the left parasternum. Based on a transmanubrial osteomuscular sparing approach, the left-upper part of the sternum and the first rib cartilage were both cut at the left clavicular-sternum joint. The posterior parts of the two ribs involving the tumor were resected at the transverse process of the vertebral bone by tearing off the anterior, middle, and posterior scalene muscles, subclavicular artery and vein. The defect size of the thorax was 15 × 9 cm, which was reconstructed by covering with a polytetrafluoroethylene dual mesh (Dual mesh, Gore tex, 2 mm). The major pectoral muscle flap was used to cover the mesh. The postoperative pathological examination diagnosed a poorly differentiated fibrosarcoma. Eventually, she had palliative therapy for the postoperative metastatic chest wall. She died 14 months after the operation.

Keywords

Surgery, Transmanubrial Osteomuscular Sparing Approach, Fibrosarcoma, The First Rib Tumor, Chest Wall Reconstruction

Conflicts of Interest

The authors declare no conflicts of interest.

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