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PubMed2004

Use of Kirschner wire in mandible reconstruction: a case report and review of the literature.

Reconstruction of massive defects in head the and neck usually requires different tissues such as skin, bone, and muscle in three-dimensional organization. Therefore, reconstruction of mandibular defects in particular include many difficulties for the head and neck, and for reconstructive surgeons. Various techniques and materials are available, and each has some advantages and disadvantages. But no materials or methods have all the reconstructive requirements. The surgeon's choice of techniques should be safe, simple, economic, and effective. We present a patient with a massive facial defect that was reconstructed successfully by using a 2-mm K wire with a free transverse rectus abdominis myocutaneous flap, and we also review the literature about the use of K wires in mandible fixation and reconstruction. We think that K wires should be kept in mind as a readily available, easily applicable, safe, inexpensive, and stable prosthetic material for mandible reconstruction, especially in cases with advanced disease.

Bone Wires↗

PubMed1993

Functional and esthetic reconstruction of a mutilated hand using multiple toe transfers and iliac osteocutaneous flap: a case report.

With reconstructive microsurgical techniques, some previously hopelessly mutilated hands have become reconstructable. The functional and esthetic results of such hands can be improved to an acceptable degree with through prereconstruction evaluation and planning. This case report demonstrates the approach to reconstruction of a mutilated hand using the following: a pedicle groin flap for soft tissue reconstruction of the first web space and the amputation stump of the thumb; a combined second and third toe transfer for reconstruction of opposable fingers at the amputated index and middle finger stumps; a single second toe for reconstruction of the thumb, and an iliac osteocutaneous flap for reconstruction of the ulnar border of the palm.

Accidents, Occupational↗

PubMed1994

Technical considerations in two-stage functioning free muscle transplantation reconstruction of both flexor and extensor functions of the forearm.

We report on two patients with severe injuries of the forearm who were reconstructed using functioning free muscle transplantation (FFMT) for individual replacement of flexor and extensor function. In both cases a two-stage procedure was performed: The extensor reconstruction preceded the flexor reconstruction by 4-6 months. The extensor digitorum communis and flexor digitorum profundus were successfully reconstructed in both cases using bilateral gracilis FFMT. In one case the flexor pollicis longus and extensor pollicis longus were also reconstructed using the adductor longus in addition to the gracilis. Clinical follow-up was a minimum of 2 years. Both patients achieved wrist control, excellent finger flexion, and metacarpophalangeal joint extension. One patient also had good interphalangeal finger extension, but the other developed a persistent claw deformity due to the lack of recovery of ulnar nerve function. Performing the extensor reconstruction prior to the flexor reconstruction theoretically allows a more rapid return of function and a shorter rehabilitation period than using the converse sequence.

Adult↗

PubMed2005

Padé methods for reconstruction and feature extraction in magnetic resonance imaging.

Methods utilizing Padé approximants are investigated for implementation with magnetic resonance imaging data and are presented both for direct image reconstruction and for feature extraction. Padé approximants are a numerical tool that can be used to accelerate the convergence of a slowly converging sequence by estimating the fully converged sequence values from early data points. Padé approximants can be calculated directly from k-space data by solving a set of linear matrix equations to produce signal values for any desired location in the image domain. This gives an estimate of the fully converged signal intensity at each pixel location in the image, raising the possibility of reconstructing a better estimate of the object from a reduced data set. These methods have been tested on phantom and human data both for image reconstruction and for feature extraction. In image reconstruction, considerable convergence acceleration can be achieved, with steep intensity boundaries reproduced in keeping with higher resolution reconstructions and oscillatory truncation artifact characteristic of Fourier reconstruction removed. The convergence acceleration is variable and there is the possibility of fine detail suppression when insufficient data are included. The use of Padé methods as a tool for feature extraction has shown good agreement with extraction from high-resolution reference data. In this approach the edge information comes intrinsically from Padé reconstruction.

Algorithms↗

PubMed2002

3D-DIASemb: a computer-assisted system for reconstructing and motion analyzing in 4D every cell and nucleus in a developing embryo.

A computer-assisted three-dimensional (3D) system, 3D-DIASemb, has been developed that allows reconstruction and motion analysis of cells and nuclei in a developing embryo. In the system, 75 optical sections through a live embryo are collected in the z axis by using differential interference contrast microscopy. Optical sections for one reconstruction are collected in a 2.5-s period, and this process is repeated every 5 s. The outer perimeter and nuclear perimeter of each cell in the embryo are outlined in each optical section, converted into beta-spline models, and then used to construct 3D faceted images of the surface and nucleus of every cell in the developing embryo. Because all individual components of the embryo (i.e., each cell surface and each nuclear surface) are individually reconstructed, 3D-DIASemb allows isolation and analysis of (1) all or select nuclei in the absence of cell surfaces, (2) any single cell lineage, and (3) any single nuclear lineage through embryogenesis. Because all reconstructions represent mathematical models, 3D-DIASemb computes over 100 motility and dynamic morphology parameters for every cell, nucleus, or group of cells in the developing embryo at time intervals as short as 5 s. Finally, 3D-DIASemb reconstructs and motion analyzes cytoplasmic flow through the generation and analysis of "vector flow plots." To demonstrate the unique capabilities of this new technology, a Caenorhabditis elegans embryo is reconstructed and motion analyzed through the 28-cell stage. Although 3D-DIASemb was developed by using the C. elegans embryo as the experimental model, it can be applied to other embryonic systems. 3D-DIASemb therefore provides a new method for reconstructing and motion analyzing in 4D every cell and nucleus in a live, developing embryo, and should provide a powerful tool for assessing the effects of drugs, environmental perturbations, and mutations on the cellular and nuclear dynamics accompanying embryogenesis.

Animals↗

PubMed1993

Rectus abdominis myocutaneous flap for primary vaginal reconstruction.

Reconstructive procedures are being performed with increasing frequency in conjunction with pelvic exenterations and other radical gynecologic surgeries. The most common reconstructive procedures include continent urinary diversion, rectosigmoid anastomosis, and vaginal reconstruction. Historically, the gracilis myocutaneous flap has been the procedure of choice for vaginal reconstruction. However, the gracilis myocutaneous flap has a history of partial to severe necrosis, a propensity to prolapse, and leaves ipsilateral donor scars on the thigh. In contrast, neovaginal reconstruction using a relatively new procedure, the distally based rectus abdominis myocutaneous flaps, has the advantage of using a large, single flap that can be incorporated into the primary incision. This flap is mobilized on a long vascular pedicle, the rectus muscle. In relation to the underlying rectus muscle, the orientation of the cutaneous portion of this flap may be customized to accommodate the pelvic defect or the surgeon's preference. Depending on their primary orientation, they are referred to as either a vertical or transverse rectus abdominis myocutaneous flap. The versatility and reliability of the rectus flap is demonstrated here through the presentation of a small pilot series of seven patients. The technique was used for vaginal reconstruction, primarily in conjunction with pelvic exenteration. The flaps were mobilized from the supraumbilical area and had a flap viability of 100% for the 2 years that they have been followed. There were no postoperative incisional or flap infections. There was one infraumbilical fascial dehiscence. The advantages of primary pelvic reconstruction along with the description of the operative techniques are presented.

Adult↗

PubMed1993

Crossbridges in the complete unit cell of rigor insect flight muscle imaged by three-dimensional reconstruction from oblique sections.

We have computed two types of 3-D reconstructions from single images of oblique transverse sections through rigor insect flight muscle (IFM) that permit simultaneous examination of all myosin crossbridges within the unit cell. One type, crystallographic serial section reconstruction (CSSR), utilizes primarily real space image manipulations of the periodic crossbridge lattice to obtain a 3-D reconstruction from a single image. The CSSRs, which do not average successive unit cells along the filament axis, reveal variations in the rigor double chevrons within the 116 nm long axial repeat and in particular show that specific crossbridges are absent. CSSRs establish that in rigor, the 116 nm period contains nine 12.9 nm repeats of attached crossbridges rather than the eight 14.5 nm repeats of myosin head origins observed in the relaxed state. This indicates that dominance of the actin repeat on myosin head form enforces axial and azimuthal changes on the crossbridge origins on the thick filament. The second type, superlattice reconstruction (SLR), is carried out entirely in Fourier space and produces an averaged reconstruction with the symmetry of the unit cell enforced. SLRs measure the 3-D transform of the complete unit cell, permitting direct comparison with X-ray diagrams from native muscle. Averaging several SLRs together has produced the highest resolution reconstruction of IFM to date. Oblique section reconstructions made by both methods confirm in greater detail the presence of two-headed lead crossbridges and single-headed rear crossbridges implying heads with differing angles and conformation. Reduced twist in the thin filament coincident with the lead crossbridge is also apparent. We have modeled several interpretations of this reduced twist in terms of structural changes in both myosin and actin at the lead bridge. In addition, these 3-D images resolve a feature just Z-ward of the rear crossbridge where antibody labeling has identified part of the large troponin complex of IFM.

Actins↗

PubMed1994

Towards atomic interpretation of F-actin filament three-dimensional reconstructions.

We have recorded dark field images of negatively stained F-actin filaments polymerized with 2 mM MgCl2 and 50 mM KCl with a scanning transmission electron microscope and computed 3-D reconstructions using a helical parameter search to optimize simultaneously the helical repeat length, the radial position of the filament axis, and the helical selection rule. The resulting optimized averaged filament 3-D reconstruction at 2.5 nm resolution is remarkably similar to an atomic model of the F-actin filament. By comparison, several structural features of the reconstruction can be interpreted at the level of distinct secondary structure elements, and predictions made by the atomic model could be verified: for instance, the density connecting the two long-pitch helical strands in our reconstruction co-localizes with an extended beta-hairpin, the "hydrophobic loop" (i.e. residues 262 to 274), which according to the atomic model establishes the major intersubunit contact between the two long-pitch helical strands. The most pronounced structural variations among individual filament 3-D reconstructions were observed in (1) the details of the intersubunit contact pattern between the two long-pitch helical strands, and (2) the exact size and shape of subdomain 2 of the F-actin molecule, which appears rather flexible and easily deformed. In addition, we found that all phenotypes of F-actin filament 3-D reconstructions that arise from small deviations from the optimal helical parameters or from lowering the nominal resolution exhibited stronger intersubunit contacts between than along the two long-pitch helical strands, a structural feature that has been emphasized for a number of F-actin filament 3-D reconstructions in the past. Since this is clearly at variance with the relative strength of the intersubunit contacts as predicted by the atomic model, it may represent an artifactual structural feature arising from low-resolution data or suboptimal helical data processing, and should therefore be interpreted with caution in terms of indicating chemical, mechanical or conformational states of the F-actin filament.

Actins↗

PubMedDate not supplied

An ab initio algorithm for low-resolution 3-D reconstructions from cryoelectron microscopy images.

A statistical method for determining low-resolution 3-D reconstructions of virus particles from cryoelectron microscope images by an ab initio algorithm is described. The method begins with a novel linear reconstruction method that generates a spherically symmetric reconstruction, which is followed by a nonlinear reconstruction method implementing an expectation-maximization procedure using the spherically symmetric reconstruction as an initial condition and resulting in a reconstruction with icosahedral symmetry. An important characteristic of the complete method is that very little need be known about the particle before the reconstruction is computed, in particular, only the type of symmetry and inner and outer radii. The method is demonstrated on synthetic cowpea mosaic virus data, and its robustness to 5% errors in the contrast transfer function, 5% errors in the location of the center of the particles in the images, and 5% distortion in the 3-D structure from which the images are derived is demonstrated numerically.

Algorithms↗

PubMed1994

Serial section electron tomography: a method for three-dimensional reconstruction of large structures.

We present a method for combining single axis tomography and serial sectioning techniques to derive a three-dimensional reconstruction of large structures at electron microscopic resolution. This serial-tomography method allows the use of sufficiently thin sections to achieve adequate resolution with electron tomography, yet enables the generation of large reconstructions with considerably fewer sections than would be required using a serial thin section reconstruction technique. Serial thick sections (1-2 microns) are cut through the structure of interest, tomographic volume reconstructions are obtained for each section from a single axis tilt series, and the resulting series of volumes are then aligned and combined to form a single large volume. The serial-tomography method is illustrated with several samples, including red blood cells, the Golgi apparatus, and a spiny dendrite of a cortical pyramidal neuron. In some of these samples, the reconstruction is compared to correlated light microscopic views. The resulting large volume reconstructions appear to represent accurately the size and shape of objects such as red blood cells and spiny dendrites. The continuity of complex, tortuous structures such as the Golgi apparatus is also maintained across serial volumes. These examples demonstrate that it is possible to align and link a series of tomographic volumes accurately and that serial-tomography is a useful method for reconstructing relatively large structures without resorting to large numbers of serial thin sections.

Animals↗

PubMed1994

Reconstruction of ancestral sequences by the inferential method, a tool for protein engineering studies.

This paper describes the inferential method, an approach for reconstructing protein and nucleotide sequences of ancestral species, starting from known, homologous, contemporary sequences. The method requires knowledge of the topology of the phylogenetic tree, whose nodes are the species to whom the reconstructed sequences belong. The method has been tested by computer simulation of speciation and nucleotide substitutions, starting from a single ancestral sequence, and by subsequent reconstruction of nodal sequences. Results have shown that reconstructions obtained by the inferential method are affected by limited error frequencies, which (1) are proportional to the squares of nucleotide substitution rates and of internodal distances, and (2) are little influenced by non-uniformity of transformation rates of nucleotides. Furthermore, good agreement of the results has been obtained by comparing protein-sequence reconstructions carried out with the inferential method with those obtained using the maximum parsimony method in two different cases: e.g., a reconstruction of simulated sequences and a reconstruction of mammalian ribonuclease sequences.

Amino Acid Sequence↗

PubMed1995

The influence of image enhancement and reconstruction on quantitative coronary arteriography.

In the coming years, cinefilm will gradually be replaced by some digital medium for the archiving of angiographic images. However, not only the question which digital archiving medium will be used in the future is important, but also which images are to be stored. Options are to either archive the raw, unprocessed images, or the enhanced images as they are displayed on the viewing monitor in the catheterization laboratory. In the first case, an off-line workstation will need additional hardware to display the images with the same image quality as they were acquired; in the second case, the question remains whether quantitative analysis programs still provide reliable results. Goal of this study was to investigate the possible effects of image enhancement and reconstruction on the results from quantitative coronary arteriographic (QCA) measurements with the Philips ACA-package (Automated Coronary Analysis). Image enhancement was achieved by an unsharp masking approach; the reconstruction of the original image from the enhanced image was attempted by an iterative deconvolution approach. The evaluation study consisted of two parts; a technical evaluation on eleven phantom tubes with known dimensions, and a clinical evaluation study on 48 coronary lesions. The results of the technical evaluation demonstrate that the measurement errors increase for the smaller vessel sizes (< 1.2 mm) when QCA is applied to reconstructed images. The systematic difference on the smallest phantom tube (0.687 mm) on unprocessed images was limited to 0.050 mm, while it increased to 0.089 mm for the reconstructed images. Moreover, the random differences for the smaller vessel sizes increased for all processed images: for 0.159 mm for the unprocessed image to 0.189 mm for the enhanced and 0.204 mm for the reconstructed image (p < 0.01). For the larger vessels, in general, no significant differences could be observed between the results of the unprocessed and processed images. The results of the clinical evaluation study demonstrate that especially the obstruction diameter is overestimated when QCA is applied to reconstructed images (0.113 mm). Although the measurements on the enhanced images did not show a significant overestimation of the obstruction diameter, the intra-observer random difference was much higher (0.199 mm for the enhanced images versus 0.140 mm for the unprocessed images, p < 0.01). In more general terms, applying QCA on enhanced images increases the random difference values, while reconstructing the original image from the enhanced images increases the systematic errors in the measured diameters. This study has clearly demonstrated that especially the smaller diameter values (< 1.2 mm) are influenced by image enhancement. Therefore, to obtain quantitative results with the desired small values for systematic and random differences, requires that the raw, unprocessed image data be archived.

Computer Systems↗

PubMed1997

Bayesian image reconstruction for emission tomography based on median root prior.

The aim of the present study was to investigate a new type of Bayesian one-step late reconstruction method which utilizes a median root prior (MRP). The method favours images which have locally monotonous radioactivity concentrations. The new reconstruction algorithm was applied to ideal simulated data, phantom data and some patient examinations with PET. The same projection data were reconstructed with filtered back-projection (FBP) and maximum likelihood-expectation maximization (ML-EM) methods for comparison. The MRP method provided good-quality images with a similar resolution to the FBP method with a ramp filter, and at the same time the noise properties were as good as with Hann-filtered FBP images. The typical artefacts seen in FBP reconstructed images outside of the object were completely removed, as was the grainy noise inside the object. Quantitatively, the resulting average regional radioactivity concentrations in a large region of interest in images produced by the MRP method corresponded to the FBP and ML-EM results but at the pixel by pixel level the MRP method proved to be the most accurate of the tested methods. In contrast to other iterative reconstruction methods, e.g. ML-EM, the MRP method was not sensitive to the number of iterations nor to the adjustment of reconstruction parameters. Only the Bayesian parameter beta had to be set. The proposed MRP method is much more simple to calculate than the methods described previously, both with regard to the parameter settings and in terms of general use. The new MRP reconstruction method was shown to produce high-quality quantitative emission images with only one parameter setting in addition to the number of iterations.

Algorithms↗

PubMed1988

Three-dimensional reconstruction of myocardial contrast perfusion from biplane cineangiograms by means of linear programming techniques.

The assessment of coronary flow reserve from the instantaneous distribution of the contrast agent within the coronary vessels and myocardial muscle at the control state and at maximal flow has been limited by the superimposition of myocardial regions of interest in the two-dimensional images. To overcome these limitations, we are in the process of developing a three-dimensional (3D) reconstruction technique to compute the contrast distribution in cross sections of the myocardial muscle from two orthogonal cineangiograms. To limit the number of feasible solutions in the 3D-reconstruction space, the 3D-geometry of the endo- and epicardial boundaries of the myocardium must be determined. For the geometric reconstruction of the epicardium, the centerlines of the left coronary arterial tree are manually or automatically traced in the biplane views. Next, the bifurcations are detected automatically and matched in these two views, allowing a 3D-representation of the coronary tree. Finally, the circumference of the left ventricular myocardium in a selected cross section can be computed from the intersection points of this cross section with the 3D coronary tree using B-splines. For the geometric reconstruction of the left ventricular cavity, we envision to apply the elliptical approximation technique using the LV boundaries defined in the two orthogonal views, or by applying more complex 3D-reconstruction techniques including densitometry. The actual 3D-reconstruction of the contrast distribution in the myocardium is based on a linear programming technique (Transportation model) using cost coefficient matrices. Such a cost coefficient matrix must contain a maximum amount of a priori information, provided by a computer generated model and updated with actual data from the angiographic views. We have only begun to solve this complex problem. However, based on our first experimental results we expect that the linear programming approach with advanced cost coefficient matrices and computed model will lead to acceptable solutions in the 3D-reconstruction of the myocardial contrast distribution from biplane cineangiograms.

Cineangiography↗

PubMed1990

Three-dimensional reconstruction of stenosed coronary artery segments with assessment of the flow impedance.

In this paper preliminary results of a study about the diagnostic benefits of 3D visualization and quantitation of stenosed coronary artery segments are presented. As is well known, even biplane angiographic images do not provide enough information for binary reconstruction. Therefore, a priori information about the slice to be reconstructed must be incorporated into the reconstruction algorithm. One approach is to assume a circular cross-section of the coronary artery. Hence, the diameter is estimated from the contours of the vessels in both projections. Another approach is to search for a solution of the reconstruction problem close to the previously reconstructed adjacent slice. In this paper we follow the first method based on contour information. The reconstructed coronary segment is visualized in three dimensions. Based on the obtained geometry of the obstruction the pertinent blood flow impedance is estimated on the basis of fluid dynamic principles. The results of applying the reconstruction algorithms to clinical coronary biplane exposure are presented with an indication of the assessed flow impedance.

Angiography↗

PubMed1994

Endosonographic assessment of the anal sphincter after surgical reconstruction.

PURPOSE: Patients with anal incontinence attributable to trauma are usually treated by sphincter reconstruction. Failures because of incomplete reconstruction may possibly be detected by anal endosonography which gives detailed information on the anal sphincter muscles. The aim of this study was to describe the endosonographic findings in patients after sphincter reconstruction. MATERIALS AND METHODS: Ten female patients who had undergone surgical sphincter reconstruction using an overlapping technique because of anal incontinence were studied with anal endosonography a median of six months after surgery. Five patients were fully continent, three were incontinent for flatus, and two patients were still incontinent for solid stool at the time of this study. Eight patients had also been studied with endosonography before surgery, and, in these patients, we compared the initial sonograms with the follow-up sonograms. The angular extent of the endosonographic defects in the external sphincter before and after reconstruction was measured in degrees and compared with the outcome of surgery. RESULTS: After reconstruction, continuity of the external anal sphincter was completely restored at all levels in four patients, one of whom still had anal incontinence. Continuity was partially restored in three patients: two were fully continent, while one patient, previously incontinent for stool, was incontinent for flatus. In three patients the continuity was restored at one level but a persisting defect was found at a different level. In two of these patients the grade of incontinence was unchanged. Three patients also had defects in the internal anal sphincter. CONCLUSION: After surgical sphincter reconstruction for anal incontinence, we found sphincteric defects in six patients, including four of five patients who still had some degree of incontinence. Thus, endosonography may be used for postoperative assessment and may explain the unsatisfactory results of surgery in some patients. We recommend that endosonography be also performed preoperatively, whereby the effect of the operation on the size of the sphincteric defect can be assessed.

Adult↗

PubMed1997

Morphometric evaluations of personalised 3D reconstructions and geometric models of the human spine.

In the past, several techniques have been developed to study and analyse the 3D characteristics of the human spine: multi-view radiographic or biplanar 3D reconstructions, CT-scan 3D reconstructions and geometric models. Extensive evaluations of three of these techniques that are routinely used at Sainte-Justine Hospital (Montréal, Canada) are presented. The accuracy of these methods is assessed by comparing them with precise measurements made with a coordinate measuring machine on 17 thoracic and lumbar vertebrae (T1-L5) extracted from a normal cadaveric spine specimen. Multi-view radiographic 3D reconstructions are evaluated for different combinations of X-ray views: lateral (LAT), postero-anterior with normal incidence (PA0 degree) and postero-anterior with 20 degrees angled down incidence (PA20 degrees). The following accuracies are found for these reconstructions obtained from different radiographic setups: 2.1 +/- 1.5 mm for the combination with PA0 degree-LAT views, and 5.6 +/- 4.5 mm for the PA0 degree-PA20 degrees stereopair. Higher errors are found in the postero-anterior direction, especially for the PA0 degree-PA20 degrees view combination. Pedicles are found to be the most precise landmarks. Accuracy for CT-scan 3D reconstructions is about 1.1 +/- 0.8 mm. As for a geometric model built using a multiview radiographic reconstruction based on six landmarks per vertebra, accuracies of about 2.6 +/- 2.4 mm for landmarks and 2.3 +/- 2.0 mm for morphometric parameters are found. The geometric model and 3D reconstruction techniques give accurate information, at low X-ray dose. The accuracy assessment of the techniques used to study the 3D characteristics of the human spine is important, because it allows better and more efficient quantitative evaluations of spinal dysfunctions and their treatments, as well as biomechanical modeling of the spine.

Evaluation Studies as Topic↗

PubMed1998

[Resection and reconstruction of sternum].

In case of sternal resection, it is necessary to preserve bone material indispensable for the stability of the anterior chest wall and air tightness of the thoracic cavity, and the support of the chest wall integrity must be restored by some means. Various techniques have been applied to the reconstruction of the chest wall following resection. During the last 10 years, we have performed reconstructive operation for 6 cases of the chest wall following resection of the sternum in recurrent cases of breast cancer or invaded case of primary breast cancer. In these patients, the chest wall was reconstructed using a rib-latissimus dorsi osteomyocutaneolus flap or a latissimus dorsi myocutaneous flap. The sternum was totally resected in 3 cases, and in all 3 cases, reconstructed using a rib-latissimus dorsi osteomyocutaneous flap. Although postoperative pulmonary function decreased, all cases could be relieved from endotracheal intubation within 17 hours after operation, and had no problems in activities of daily living or occurrence of chest flailing or paradoxical movement of the chest. An artificial material (expanded polytetrafluoroethlene patch) was used in only one patient for the reconstruction of the osseous thorax, but this case developed infection during postoperative chemotherapy. After this experience, we used only biological materials for the reconstruction of the chest wall and postoperatively performed radiotherapy and/or chemotherapy on all cases. We have observed no flap infection or detachment since then. One characteristic of using the latissimus dorsi myocutaneous flap is that it is easily elevated and rarely causes serious postoperative esthetic or functional problems. The flap is also easily utilized to reinforce the osseous thorax because ribs immediately below the latissimus dorsi muscle are readily mobilized as a pedicle graft. Reconstruction of the chest wall following resection of the sternum, described in this report, allowed us to perform radiotherapy and/or chemotherapy without serious postoperative complications on the cases relapsing after treatment of breast cancer. The 2-year survival rate is 50% and one of these cases survived up to 10 years after resection of the sternum. Thus we prefer to perform resection of the sternum for sternal recurrence of breast cancer if there are no metastatic lesions in other organs.

Adult↗