Objective: This video case review demonstrates the radical resection and novel reconstruction of an isolated renal cell carcinoma to the manubrium through a multi-specialty approach.

Methods: Resection proceeded with dissection and creation of pectoralis muscle flaps, followed by distal sternal division at the level of the second intercostal space and division of the costal margins of the first and second ribs. Vascular attachments to the posterior table of the manubrium were dissected and the sternoclavicular joints resected. Margins were negative and Merseline tape was used to anchor free-floating clavicle and first rib. A Vicryl mesh was secured to soft tissue and bone edges of the remaining defect and provide barrier between the bone graft and pericardium/mediastinal soft tissue.Simultaneously, bilateral iliac wing allografts were harvested by orthopedic surgery. This was morselized and combined with acellular cadaveric bone and vancomycin paste to fill the defect. A bioabsorbable plate was soaked in hot water and molded to the natural curvature of the chest wall above the bone graft and secured in place. Pectoralis advancement flaps were created by plastic surgery and secured over the plate.

Results: The patient was discharged uneventfully, and all skeletal margins were negative, with tumor invasive to pectoralis major muscle that was removed en-bloc. He did develop a seroma above the pec flap which was managed conservatively.

Conclusions: Radical resection and reconstruction of the manubrium with combined iliac bone allograft and bioabsorbable plate is safe and feasible.