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.
Highlights
IntroductionPrimary chest wall tumors are uncommon and more than half are malignant, and most of these are the result of
Primary chest wall tumors are uncommon and more than half are malignant, and most of these are the result ofHow to cite this paper: Ayabe, T., Tomita, M., Mori, H., Chosa, E. and Nakamura, K. (2015) A Resection of the Giant First Left Rib Tumor and Chest Wall Reconstruction by Transmanubrial Osteomuscular Sparing Approach
The rib tumors are the most frequently detected and are malignant tumors, the first rib tumor is considered to be the rarest location and we found one case report in English [2]
Summary
Primary chest wall tumors are uncommon and more than half are malignant, and most of these are the result of. Primary and metastatic, can arise from or involve any portion of the thoracic skeleton, including the ribs, sternum, scapulae, and clavicles. Due to its anatomical complexity, such as the narrow space between the sternum and clavicle, and the first and second ribs, which space is forming the entrance of the subclavian artery, brachiocephalic vein, brachial plexus from the thorax, there are various muscle involvements of the anterior, middle, posterior scalene, sternocleidomastoid, and pectoralis major ones. Several authors have described different approaches and with different degrees of invasion to this anatomical area This challenge is similar to that created by apical bronchopulmonary tumors in adults, which involve structures of the cervicothoracic junction. To resect the first and second rib tumors, we performed a transmanubrial approach, a surgical technique which is generally useful for the resection of cervico-thoracic tumors. This report presents our experience in the use of this less invasive cervico-thoracic approach underlying its versatility in approaching different tumors such as the first and second rib ones
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