Daliakopoulos et al. Journal of Medical Case Reports 2010, 4:75 http://www.jmedicalcasereports.com/content/4/1/75 C A S E R E P O R T JOURNAL OF MEDICAL CASE REPORTS Open Access Solitary metastatic adenocarcinoma of the sternum treated by total sternectomy and chest wall reconstruction using a Gore-Tex patch and myocutaneous flap: a case report Stavros I Daliakopoulos1*, Michael N Klimatsidas2, Reiner Korfer1 Abstract Introduction: The consequences of bone metastasis are often devastating. Although the exact incidence of bone metastasis is unknown, it is estimated that 350,000 people die of bone metastasis annually in the United States. The incidence of local recurrences after mastectomy and breast-conserving therapy varies between 5% and 40% depending on the risk factors and primary therapy utilized. So far, a standard therapy of local recurrence has not been defined, while indications of resection and reconstruction considerations have been infrequently described. This case report reviews the use of sternectomy for breast cancer recurrence, highlights the need for thorough clinical and radiologic evaluation to ensure the absence of other systemic diseases, and suggests the use of serratus anterior muscle flap as a pedicle graft to cover full-thickness defects of the anterior chest wall. Case presentation: We report the case of a 70-year-old Caucasian woman who was referred to our hospital for the management of a retrosternal mediastinal mass. She had undergone radical mastectomy in 1999. Computed tomography and magnetic resonance imaging revealed a 74.23 × 37.7 × 133.6-mm mass in the anterior mediastinum adjacent to the main pulmonary artery, the right ventricle and the ascending aorta. We performed total sternectomy at all layers encompassing the skin, the subcutaneous tissues, the right pectoralis major muscle, all the costal cartilages, and the anterior part of the pericardium. The defect was immediately closed using a 0.6 mm Gore-Tex cardiovascular patch combined with a serratus anterior muscle flap. Our patient had remained asymptomatic during her follow-up examination after 18 months. Conclusion: Chest wall resection has become a critical component of the thoracic surgeon’s armamentarium. It may be performed to treat either benign conditions (osteoradionecrosis, osteomyelitis) or malignant diseases. There are, however, very few reports on the results of full-thickness complete chest wall resections for locally recurrent breast cancer with sufficient safety margins, and even fewer reports that describe the operative technique of using the serratus anterior muscle as a pedicled flap. Introduction Bone metastasis is a frequent complication of cancer. It occurs in up to 70% of patients with advanced breast or prostate cancer and in approximately 15% to 30% of patients with carcinoma of the lung, colon, stomach, bladder uterus, rectum, thyroid or kidney. Breast cancer has the tendency to relapse in the bones, and 56% of * Correspondence: sdaliakopoulos@hotmail.de 1Herz-und Diabeteszentrum Nordrhein Westfalen, Georgstrasse 11, Bad Oeynhausen, Universitätsklinikum der Ruhr-Universität Bochum, Germany autopsy cases reveal the occurrence of bone metastasis. The most frequent sites of bone metastasis are the thor- acic and lumbosacral spine. The consequences of bone metastasis are often devastating, as only 20% of patients with breast cancer are still alive five years after the dis- covery of bone metastasis. Chest wall resection for breast cancer was first performed by Schede in 1866 and then by Sauerbruch in 1907. Meanwhile, partial sternectomy for a primary sarcoma was first described by Holden in 1878. In 1959, Brodin and Linden first © 2010 Daliakopoulos et al; licensee BioMed Central Ltd. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.