Abstract / Summary
A 75-year-old man underwent en bloc resection of a high-grade, poorly differentiated sternal neoplasm.An earlier incisional biopsy had resulted in approximately 3.5 L of blood loss, hemodynamic instability, and the need for emergency damage control surgery.The definitive procedure involved removal of the sternal body, bilateral costal cartilages, and medial insertions of both pectoralis major muscles, leaving a large fullthickness defect in the anterior chest wall.Reconstruction was undertaken in stages.After serial debridement and negative-pressure wound therapy (NPWT), skeletal stability was restored with three titanium bars and a 25 × 10 cm polypropylene mesh.A 25 × 10 cm polypropylene mesh (BioMesh; Unilene SAC, Lima, Peru), matching the dimensions of the anterior chest wall defect, was then applied over the titanium framework.The remaining pectoral tissues could not be advanced sufficiently to cover the central defect; therefore, a superiorly based right rectus abdominis muscle flap was used to provide vascularized coverage, followed by a split-thickness skin graft (STSG).Graft incorporation was estimated at 97% on postoperative day (POD) 5 and 98% on day 7.At approximately six months, the wound remained healed, the chest wall contour was preserved, and no fixation material was exposed.At 8.5 months, the chest computed tomography (CT) report described postoperative changes without a residual or recurrent mass at the operative site; the patient also reported maintaining his usual daily activities.In this setting, the pedicled rectus abdominis flap provided reliable coverage of an extensive anterior chest wall defect when conventional pectoralis advancement was not feasible and staged reconstruction was required because of the patient's earlier physiological and wound-related complications.