1. The “Rib-Like” Technique for Surgical Treatment of Sternal Tumors: Lessons Learned From 101 Consecutive Cases 
Paolo Girotti, MD, Francesco Leo, MD, PhD, Francesca Bravi, PhD, Luca Tavecchio, MD, Andrea Spano, MD, Umberto Cortinovis, MD, Maurizio Nava, MD, Ugo Pastorino, MD 
The Annals of Thoracic Surgery 
Volume 92, Issue 4, Pages (October 2011)
DOI: /j.athoracsur
Copyright © 2011 The Society of Thoracic Surgeons Terms and Conditions

2. Fig 1
The rib-like prosthesis is modeled using (A) an aluminium cast that is (B) covered by a nonabsorbable mesh. (C) Cast tracks are filled over the mesh with radiopaque acrylic resin and methyl methacrylate resin. (D) Once the exothermic reaction is completed and redundant mesh is cut away, the prosthesis is washed and then fixed to the costal stumps. Clavicular stumps can also be fixed to the graft when required (arrows).
The Annals of Thoracic Surgery  , DOI: ( /j.athoracsur )
Copyright © 2011 The Society of Thoracic Surgeons Terms and Conditions

3. Fig 2
Actuarial curve shows survival according to the type of sternal tumors: primary neoplasms (n = 42), breast cancer (n = 30), locally advanced tumors (lung cancer, n = 8; tyroid cancer, n = 4; thymoma, n = 1; and skin cancer, n = 2), and metastasis (n = 11). Patients with a primary neoplasm had significantly better long-term survival (p < 0.02) than patients with others cancers.
The Annals of Thoracic Surgery  , DOI: ( /j.athoracsur )
Copyright © 2011 The Society of Thoracic Surgeons Terms and Conditions

4. Fig 3
Actuarial survival is shown according to past chest wall operations. Prognosis was significantly better (p < 0.01) in patients whose resection was adequate at the first attempt compared with patients who had previous chest operations.
The Annals of Thoracic Surgery  , DOI: ( /j.athoracsur )
Copyright © 2011 The Society of Thoracic Surgeons Terms and Conditions

5. Fig 4
Actuarial survival is shown depending on purpose of the operation: patients who received curative treatment (n = 76) vs patients who required palliative procedures (n = 25). Patients who required palliative treatment had worse long-term survival; however, 5-year survival in palliative patients was 26.9%.
The Annals of Thoracic Surgery  , DOI: ( /j.athoracsur )
Copyright © 2011 The Society of Thoracic Surgeons Terms and Conditions

6. Fig 5
(A) Fracture and displacement (red circle) of a rigid methacrylate prosthesis placed after total sternectomy. (B) Total sternectomy and bilateral I-VII rib resection. (C) The rib-like prosthesis is anchored to the rib stumps. (D) A tridimensional computed tomography scan shows the reconstruction at 7 days.
The Annals of Thoracic Surgery  , DOI: ( /j.athoracsur )
Copyright © 2011 The Society of Thoracic Surgeons Terms and Conditions