Resection of the sternum for tumors : with a report of two cases and a table of seventeen previously reported cases / by W.W. Keen.

  • William Williams Keen
Date:
1897
Catalogue details

Licence: Public Domain Mark

Credit: Resection of the sternum for tumors : with a report of two cases and a table of seventeen previously reported cases / by W.W. Keen. Source: Wellcome Collection.

Provider: This material has been provided by The Royal College of Surgeons of England. The original may be consulted at The Royal College of Surgeons of England.

    7/12 (page 5)
    the sternum and also the cartilages of' the second and third ribs, as well as the inter- costal muscle between them, seemed to be involved, I removed both the cartilages and also the intercostal tissues down to the pleura. The internal mammary artery was divided and secured by a curved needle passing through the thinned wall of the pleural cavity. A considerable portion (about lxlj inches) of both the manubrium and the gladiolus was then removed by the double rongeur forceps until apparently healthy bone was reached. The right breast was then removed, to- gether with a layer of the pectoral muscle and all of its fascia, and the right axilla cleaned out. At the end of the opera- tion the woman was in a very precarious condition, but under stimulants and strychnin she revived. Her highest tem- perature only once exceeded 101°. During April her temperature again rose and remained for some time above and below 100°, but she finally made a good recovery. While I was away on my summer holiday I learned that the disease returned, and that she died in the following August. Dr. Kyle made the following report on the specimen: “Sections showed all the tissue to be infiltrated (malignant). The periosteum was thickened and cancerous. Also there was a small piece of the inter- costal tissue extending down to the pleura, which, while not so much thickened, showed evidence of malignancy. The section of the rib or cartilage showed in- filtration only on the upper side, which extended to the inferior margin. The cen- tral portion showed no evidence of malig- nancy.” RESECTION OF THE STERNUM for any cause, but especially for tumors, is rare. In 1859 Heyfelder3 was able to col- lect only twenty-five cases of resection for all causes from the time of Galen down- ward, and even of these six were su- perficial resections; and Steinheil4 states that, apart from the cases very briefly reported by Otis in the History of our :i Lehrbuch der Rcsectionen, p. 304. 1 Central blatt f. Chirurgie, May 25, 1889. Civil War, there were only thirty-six au- thentic cases reported. Mynter later, in 1891,® was able to find only two cases of resection for tumors besides his own. From various sources 1 have been able to collect in all seventeen cases, to which I have added the two cases reported in this paper, making a total of nineteen cases of resection of the sternum for tumors. I have excluded the superficial resections for exostosis, etc.; such as Weinlecluier reports,6 in which a colloid sarcoma of the breast was removed, together with an ossifying enchondroma of the gladiolus, as only the superficial layers of the bone were resected. I have restricted myself to those cases in which the entire thick- ness of the bone was removed, in seven- teen out of the nineteen cases for tumor of the sternum, and in two cases lor the removal of retro-sternal fibroids. More or less of the sternum has . been removed for various purposes : (1.) To obtain access to the great ves- sels in order to ligate them. Bardenheuer7 has advocated resection of the manubrium in cases in which it is impossible to ligate the subclavian or the innominate artery or veins at the usual points. This seems, I confess, a very heroic procedure. I do not know of any recorded case in which it has been necessary. (2.) For fractures, and especially gun- shot fracture of the sternum. The most extensive statistics are those of Otis,8 who records fifty-one cases, with a mortality of 18, or 35.3 per cent. He illustrates with an excellent chromo-lithograph9 a fright- ful wound of the sternum from canister, from which the patient recovered and lived many years. Through the wound the pulsation of the aorta could be plainly perceived. Otis refers also10 to the case of the, son of the Viscount Montgomery, who was injured by a severe fall, and fractured the ribs on the left side. An immense abscess formed, and a 5 Annals of Surgery. XIII., 906 ° Bericht der K. K. Kaiseranstalt Rudolph Stiftung, 1871, Wien, 1873, p. 24. 7 Deutsche medicin. Wochensehr., 1885, II., 688. 8 Medical and Surgical History of the War of the Rebel- lion. Surgical Volume, Part 1, pp. 486 and 571. ,J Op. Cit. Opposite page 486. 10 Op. Cit., p. 571.