title: Post-operative pulmonary and shoulder function after sternal reconstruction for patients with chest wall sarcomas.
abstract: BACKGROUND
  Sternal resection is occasionally required for patients with malignant tumors, particularly sarcomas, in the sternal region. Few reports have described post-operative respiratory and shoulder function after sternal resection for patients with bone and soft-tissue sarcomas.
  
  
  METHODS
  Eight consecutive patients with bone and soft tissue sarcomas requiring sternal resection were the focus of this study. Chest wall was reconstructed with a non-rigid or semi-rigid prosthesis combined, in most cases, with soft tissue flap reconstruction. Clinical outcomes investigated included complications, shoulder function, evaluated with Musculoskeletal Tumor Society-International Symposium of Limb Salvage system, and respiratory function, evaluated by use of spirometry.
  
  
  RESULTS
  The anterior chest wall was reconstructed with non-rigid strings for 3 patients and with polypropylene mesh for 5. There were no severe post-operative complications, for example surgical site infection or pneumonia. All 3 patients with non-rigid reconstruction experienced paradoxical breathing, whereas none with polypropylene mesh did so. Post-operatively, FEV(1)% was unchanged but %VC was significantly reduced (p = 0.01), irrespective of the reconstruction method used (strings or polypropylene mesh). Shoulder function was not impaired.
  
  
  CONCLUSIONS
  Among patients undergoing sternal resection, post-operative shoulder function was excellent. Pulmonary function was slightly restricted, but not sufficiently so to interfere with the activities of daily living (ADL). Paradoxical breathing is a slight concern for non-rigid reconstruction.
authors.affiliation: Department of Orthopaedic Surgery, Nagoya University Graduate School and School of Medicine, 65 Tsurumai, Showa, Nagoya, Aichi, 466-8550, Japan. ynishida@med.nagoya-u.ac.jp.
authors.forename: Yoshihiro
authors.initials: Y
authors.lastname: Nishida
authors.affiliation: Department of Orthopaedic Surgery, Nagoya University Graduate School and School of Medicine, 65 Tsurumai, Showa, Nagoya, Aichi, 466-8550, Japan.
authors.forename: Satoshi
authors.initials: S
authors.lastname: Tsukushi
authors.affiliation: Department of Orthopaedic Surgery, Nagoya University Graduate School and School of Medicine, 65 Tsurumai, Showa, Nagoya, Aichi, 466-8550, Japan.
authors.forename: Hiroshi
authors.initials: H
authors.lastname: Urakawa
authors.affiliation: Department of Plastic and Reconstructive Surgery, Nagoya University Graduate School and School of Medicine, 65 Tsurumai, Showa, Nagoya, 466-8550, Japan.
authors.forename: Kazuhiro
authors.initials: K
authors.lastname: Toriyama
authors.affiliation: Department of Plastic and Reconstructive Surgery, Nagoya University Graduate School and School of Medicine, 65 Tsurumai, Showa, Nagoya, 466-8550, Japan.
authors.forename: Yuzuru
authors.initials: Y
authors.lastname: Kamei
authors.affiliation: Department of Thoracic Surgery, Nagoya University Graduate School and School of Medicine, 65 Tsurumai, Showa, Nagoya, 466-8550, Japan.
authors.forename: Kohei
authors.initials: K
authors.lastname: Yokoi
authors.affiliation: Department of Orthopaedic Surgery, Nagoya University Graduate School and School of Medicine, 65 Tsurumai, Showa, Nagoya, Aichi, 466-8550, Japan.
authors.forename: Naoki
authors.initials: N
authors.lastname: Ishiguro
mesh_terms: D000203:Activities of Daily Living; D000328:Adult; D000368:Aged; D001859:Bone Neoplasms / Q000601:surgery*; D005260:Female; D005541:Forced Expiratory Volume; D006801:Humans; D008297:Male; D008875:Middle Aged; D011184:Postoperative Period; D019736:Prostheses and Implants / Q000009:adverse effects; D019651:Plastic Surgery Procedures / Q000009:adverse effects; D012509:Sarcoma / Q000473:pathology / Q000601:surgery*; D012782:Shoulder / Q000503:physiopathology*; D012983:Soft Tissue Neoplasms / Q000601:surgery*; D013147:Spirometry; D013249:Sternum / Q000601:surgery*; D013524:Surgical Flaps; D013526:Surgical Mesh / Q000009:adverse effects; D035441:Thoracic Wall / Q000601:surgery*; D016896:Treatment Outcome; D014797:Vital Capacity
keywords: Paradoxical breathing; Respiratory function; Sarcoma; Shoulder function; Sternectomy