Daliakopoulos et al. Journal of Medical Case Reports 2010, 4:75 http://www.jmedicalcasereports.com/content/4/1/75 Page 5 of 8 Figure 5 Immediate closure of the skin after the end of the procedure. myocutaneous flap was then secured with heavy non- absorbable suture over the Gore-Tex mesh. Pathology revealed a poorly differentiated invasive car- cinoma infiltrating our patient’s sternum with the invol- vement of the pericardium (Figure 6). The amplification of the human factor margins was clear, while immuno- histochemistry was negative. Epidural analgesia was employed in the immediate postoperative period. Postoperative respiratory function tests revealed satisfactory results and our patient could be relieved from endotracheal intubation a day after the operation. She did not have any problems in her daily activities or any occurrence of chest flailing or paradoxi- cal movement of the chest. Scapular winging occurred although any effort was made to preserve the a third of the lower part of her serratus anterior muscle. No flap infection or wound dehiscence was noted, and she was discharged from the hospital nine days after the operation. She received two additional cycles of CEF chemother- apy consisting of 2 cycles of oral cyclophosphamide at a dose of 75 mg/m2 on days 1 through 14, 60 mg/m2 of epirubicin on days 1 and 8, and 500 mg/m2 of fluorour- acil intravenously on days 1 and 8. During her CEF therapy she also received antibiotic prophylaxis with ciprofloxacin at a dose of 500 mg orally twice daily. She is well 18 months after the diagnosis, and she exhibited no evidence of recurrent disease on serial CT and MRI