Wide resection and reconstruction using the sandwich technique for primary undifferentiated pleomorphic sarcoma of the sternum: a case report.

BACKGROUND

Primary undifferentiated pleomorphic sarcoma (UPS) of the sternum is rare, and surgical resection remains the mainstay of treatment. Extensive sternal resection necessitates reconstruction to preserve respiratory function, protect mediastinal structures, and maintain upper limb support. Various reconstruction techniques have been described, but optimal methods for high-risk patients remain unclear. We report a case of total sternal resection reconstructed using a sandwich technique with polymethyl methacrylate (PMMA) and polytetrafluoroethylene (PTFE) sheets. CASE PRESENTATION: A 79-year-old man with multiple comorbidities presented with a painful anterior chest wall mass. Imaging revealed a 3-cm localized sternal lesion, and biopsy confirmed UPS. Total sternal resection was performed, preserving the left pectoralis major muscle for flap coverage. A PMMA sheet sandwiched between PTFE sheets was anchored to the ribs, providing rigid yet lightweight chest wall support. A pedicled pectoralis major musculocutaneous flap covered the defect. Postoperative recovery was uneventful, with preserved pulmonary and upper limb function. Histopathology confirmed negative margins. At 8 months, a solitary left supraclavicular lymph node metastasis was treated with radiotherapy. The patient remains progression-free at 18 months.

CONCLUSION

Total sternal resection followed by sandwich technique reconstruction can provide stable chest wall support while preserving respiratory and upper limb function, even in elderly patients with comorbidities. This case highlights atypical metastatic patterns of sternal sarcomas, emphasizing the need for careful follow-up. The sandwich technique is a safe and reproducible option for extensive sternal reconstruction in high-risk patients.