Sternal tumors are uncommon; however, they are of different pathological types, such as sarcoma and metastatic tumors of the breast, thyroid, kidney, and colon. Such tumors require wide and full-thickness resection for complete removal. King et al. [
1] recommended a 4-cm free margin for highly aggressive primary tumors and 2-cm margins for metastatic, benign, or low-grade malignancies to avoid local recurrences. In any case, complete resection of the sternal tumor results in a wide defect on the anterior chest wall.
Various procedures have been used to reconstruct wide defects of the anterior chest wall. The ideal prosthetic material should be easily available, durable, easily usable, adaptable, rigid, resistant to infection, translucent to radiographs, and of low cost. Generally, polypropylene mesh sheets or polytetrafluoroethylene patches (e-PTFE) covered with a musculocutaneous flap are used [
2]. However, their rigidity is insufficient to protect intrathoracic organs. Various prostheses have been used, with sufficient rigidity, such as sandwiched polypropylene mesh and stainless steel mesh [
3], methyl methacrylate sandwiched between polypropylene mesh [
4], titanium plate-supported methyl methacrylate sandwich [
5], titanium plate with Gore-Tex
® dual mesh [
6], and Composix Mesh
™ [
7]. However, methyl methacrylate is not easy to handle and is difficult to adapt to the shape of the patient’s chest. Titanium Mini Mesh Sheet has strong rigidity, no plasticity, translucency to radiography, magnetic resonance imaging (MRI) compatibility, and biocompatibility. We think that the combination of a metal material and a mesh is an appropriate prosthesis, because of its durability, ease of use, adaptability, rigidity, and translucency to radiography. The advantages of the present procedure are based on the easy use of the titanium plate, irrespective of the shape of the defect and the physiological nature of the material. The titanium plate is used to provide protection for intrathoracic organs, while the polypropylene mesh is flexible in both vertical directions and thus allows movement of the chest wall during breathing.
In conclusion, the procedure with the titanium plate sandwiched between two polypropylene meshes achieved good fixation and flexibility. In patients who require extensive anterior chest wall and sternal resection, this technique may be suitable for reconstruction.