A 60-year-old woman with a history of thyroid carcinoma.
After being treated for 6 years, she comes to consultation for presenting a tumor in the sternum, 5 cm in diameter, with non-contrast appearance of the external table and bone spongy, compatible with bone metastasis
The extension study was negative.
Resection of the sternum was performed in the upper two thirds of the sternum.
After resection of the piece, there was consolidation of the right mammary artery and vein, which had to be connected, with which left mammary vessels were exposed and dissected.
Several perforating vessels originating in the left mammary artery had to be connected too.
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The reconstruction was performed with a left abdominal rectus muscle flap with vertical skin island (VRAM).
We chose to dissect the deep inferior epigastric vessels to try to reinforce perfusion and drainage of the flap by suturing the right mammary vessels.
Thus, after rotating the flap to locate it in the thoracic defect, thermo-terminal microsurgical anastomoses were performed, from the deep inferior epigastric artery to the stump of the right mammary artery.
The rectus abdominis muscle was sutured to the costal arches for bone closure.
The patient was discharged on the ward the day after the intervention and at home 7 days later.
One year after surgery, the patient evolved favorably.
