PMC:2844379 / 16704-18951 JSONTXT

{"project":"2_test","denotations":[{"id":"20193081-16440168-61863354","span":{"begin":1625,"end":1627},"obj":"16440168"},{"id":"20193081-6695023-61863355","span":{"begin":1628,"end":1630},"obj":"6695023"},{"id":"20193081-2428242-61863356","span":{"begin":1850,"end":1852},"obj":"2428242"}],"text":"Conclusions\nThe most important task as a thoracic surgeon assessing a patient with a solitary metastatic carcinoma of the sternum is to determine the tumor's likelihood of recurrence after surgery and its amenability to a complete resection. The extensive literature on relapsed breast cancer demonstrates that patients with bone metastasis coincident with the initial presentation of their breast cancer have the best outlook, while histological grade and type are the next most important prognostic factors. Patients with grades I and II ductal or lobular cancers have better prognosis than those with grade III tumors. Estrogen receptor positivity, a long disease-free interval (\u003e3 years versus \u003c3 years) and a pre-menopausal status are other factors that predict a longer survival of patients. In the case of our patient, the recurrence after 9 years following mastectomy, chemotherapy and radiotherapy led us to treat the sternal metastasis aggressively.\nThe localization of the probable defect after resection, its depth, width, convenient tissue flaps, and the tissue amount necessary for reconstruction must be evaluated pre-operatively. The serratus anterior muscle is a reliable muscle flap with a consistently long pedicle and excellent malleability, thus permitting the coverage of complex three dimensional wounds. It has been successfully used for flap reconstruction of the lower limps, dorsal surface hand defects, injuries to the head, neck and extremities, as well as bony and soft tissue defects in the face. There are only a few cases of flap reconstruction in relation to anterior thoracic wall defects [18,19].\nMetastatic breast cancer confined to the skeletal system is a complication that can be diagnosed relatively easily. It is highly responsive to treatment and it is frequently associated with extended patient survival [20]. As our experience in solid recurrent breast cancer sternal metastasis teaches, full thickness chest wall resection remains integral in controlling major complications associated with the chest wall reconstruction because it improves the quality of our patient's life, may provide patients with durable disease-free remission, and can improve survival with low mortality and morbidity results."}