PMC5994733_01
Left: Pre-operative photo of the patient showing the anticipated size of the defect. Note the radiation skin changes. Right: the surgical defect following the oncologic resection resulted in subtotal sternectomy, resection of ribs and sternal origins of bilateral pectoralis major muscles.
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PMC5994733_01_gr1.jpg
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We present a 35 year old mechanic with spindle cell sarcoma of the sternum who presented with a 3.7 x 3.1 x 7.0 cm sternal mass on chest CT (Fig. 1).
Left: In house 3D-printed model of the sternal tumor. Right: Posterior view showing the relationship of the tumor to the internal mammary vessels (IMV) on both sides. The tumor was centered on the right IMVs. The left proximal IMVs were used for microvascular reconstruction.
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After VSP, a 3D printed model was made in house, showing the relationship of the internal mammary vessels (IMV) to the tumor on both sides (Fig. 2).
Left: The microvascular anastomoses are shown prior to flap inset over mesh (white).Right: The ALT flap fascia was used as an additional vascular layer to cover the Gore-Tex mesh (white).
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Semi-rigid reconstruction of the sternum proceeded with Gore  DUALMESH  and the soft tissue defect in this radiated bed was reconstructed with an anterolateral thigh flap. (Fig. 3) The Gore-Tex mesh used was a standard mesh and not 3D printed for this specific case.