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Sparreboom CL, Hop MJ, Mazaheri M, Rothbarth J, Maat AP, Corten EM, Mureau MA. Surgical Outcomes after Full Thickness Chest Wall Resection Followed by Immediate Reconstruction: A 7-Year Observational Study of 42 Cases. JPRAS Open 2024; 41:14-24. [PMID: 38845680 PMCID: PMC11153933 DOI: 10.1016/j.jpra.2024.04.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/29/2024] [Accepted: 04/15/2024] [Indexed: 06/09/2024] Open
Abstract
Introduction Reconstruction of full thickness chest wall defects is challenging and is associated with a considerable risk of complications. Therefore, the aim of this study was to investigate the surgical outcomes and their associations with patient and treatment characteristics following full thickness chest wall reconstruction. Patients and methods A retrospective observational study was performed by including patients who underwent reconstruction of full thickness chest wall defect at the Erasmus MC between January 2014 and December 2020. The type of reconstruction was categorized into skeletal and soft tissue reconstructions. For skeletal reconstruction, only non-rigid prosthetic materials were used. Patient and surgical characteristics were retrieved and analyzed for associations with postoperative complications. Results Thirty-two women and 10 men with a mean age of 60 years were included. In 26 patients (61.9%), the reconstruction was performed using prosthetic material and a soft tissue flap, in nine cases (21.4%) only a soft tissue flap was used, and in seven other patients (16.7%) only the prosthetic material was used. Pedicled musculocutaneous latissimus dorsi flaps were used most often (n=17), followed by pectoralis major flaps (n=8) and free flaps (n=8). Twenty-two patients (52.4%) developed at least one postoperative complication. Wounds (21.4%) and pulmonary (19.0%) complications occurred most frequently. Five (11.9%) patients required reoperation. There were no associations between patient and treatment characteristics and the occurrence of major complications. There was no mortality. Conclusions Reconstruction of full thickness chest wall defects using only non-rigid prosthetic material for skeletal reconstruction appears safe with an acceptable reoperation rate and low mortality, questioning the need for rigid fixation techniques.
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Affiliation(s)
- Cloë L. Sparreboom
- Department of Plastic and Reconstructive Surgery, Erasmus MC Cancer Institute, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - M. Jenda Hop
- Department of Plastic and Reconstructive Surgery, Erasmus MC Cancer Institute, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Masood Mazaheri
- Department of Plastic and Reconstructive Surgery, Erasmus MC Cancer Institute, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Joost Rothbarth
- Department of Surgical Oncology and Gastrointestinal Surgery, Erasmus MC Cancer Institute, University Medical Center Rotterdam, Rotterdam, the Netherlands
| | - Alexander P.W.M. Maat
- Department of Cardiothoracic Surgery, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Eveline M.L. Corten
- Department of Plastic and Reconstructive Surgery, Erasmus MC Cancer Institute, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Marc A.M. Mureau
- Department of Plastic and Reconstructive Surgery, Erasmus MC Cancer Institute, University Medical Center Rotterdam, Rotterdam, The Netherlands
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Palmesano M, Lisa A, Storti G, Bottoni M, Gottardi A, Colombo G, Barbieri B, Garusi C, Sala P, Lo Iacono G, Spaggiari L, De Lorenzi F, Cervelli V, Rietjens M. Resection to restoration: Assessing the synergy of polypropylene mesh (Marlex®) combined with methyl-methacrylate and latissimus dorsi flap for primary chest wall sarcomas. J Plast Reconstr Aesthet Surg 2024; 93:157-162. [PMID: 38691953 DOI: 10.1016/j.bjps.2024.04.022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2023] [Revised: 02/13/2024] [Accepted: 04/05/2024] [Indexed: 05/03/2024]
Abstract
BACKGROUND Chest-wall sarcomas are treated with extensive resections and complex defect reconstruction to restore chest-wall integrity. It is a difficult surgical procedure that incorporates a multidisciplinary approach for the best outcome, preventing paradoxical chest movement issues and reducing complications. OBJECTIVE We aimed to describe our experience of chest-wall reconstruction using polypropylene mesh (Marlex® Mesh) combined with methyl-methacrylate and soft-tissue coverage with a latissimus dorsi flap following sarcoma resection. PATIENTS AND METHODS Among the 53 patients treated for primary chest-wall sarcomas at the European Institute of Oncology (IEO) in Milan, Italy, from 1998 to 2020, 14 cases underwent chest-wall resection and reconstruction using polypropylene mesh, methyl-methacrylate and the latissimus dorsi flap. Patients with locally advanced breast cancers, locally advanced lung cancers, squamous cell carcinomas, and other secondary chest-wall malignancies were excluded from the study, as were the patients with different types of chest-wall reconstruction. RESULTS In this study, 14 patients (6 men and 8 women) with various primary chest-wall sarcomas were enrolled. On an average, 2 ribs (range: 1-5) were removed during the surgeries, and the chest-wall defects ranged from 20 to 150 cm2 with an average size of 73 cm2. The mean follow-up period for these patients was approximately 63.80 months CONCLUSION: The combination of Marlex® mesh filled with methyl-methacrylate and covered using latissimus dorsi myocutaneous flap provides safe, low-cost and effective single-stage chest-wall reconstruction after surgery for primary sarcomas.
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Affiliation(s)
- Marco Palmesano
- Department of Plastic Surgery, University of Rome "Tor Vergata," Viale Oxford 81, Rome, Italy
| | - Andrea Lisa
- Department of Plastic and Reconstructive Surgery, European Institute of Oncology, IRCCS, 20141 Milan, Italy; Humanitas University Department of Biomedical Sciences, Humanitas University, Via Rita Levi Montalcini 4, Pieve Emanuele, Milan 20090, Italy; PhD Program in Applied Medical-Surgical Sciences, Department of Surgical Sciences, University of Rome "Tor Vergata," Viale Oxford 81, 00133 Rome, Italy
| | - Gabriele Storti
- Department of Plastic Surgery, University of Rome "Tor Vergata," Viale Oxford 81, Rome, Italy
| | - Manuela Bottoni
- Department of Plastic and Reconstructive Surgery, European Institute of Oncology, IRCCS, 20141 Milan, Italy
| | - Alessandra Gottardi
- Department of Plastic and Reconstructive Surgery, European Institute of Oncology, IRCCS, 20141 Milan, Italy
| | - Giulia Colombo
- Department of Plastic and Reconstructive Surgery, European Institute of Oncology, IRCCS, 20141 Milan, Italy
| | - Benedetta Barbieri
- Department of Plastic and Reconstructive Surgery, European Institute of Oncology, IRCCS, 20141 Milan, Italy
| | - Cristina Garusi
- Department of Plastic Surgery, University of Rome "Tor Vergata," Viale Oxford 81, Rome, Italy
| | - Pietro Sala
- Department of Plastic and Reconstructive Surgery, European Institute of Oncology, IRCCS, 20141 Milan, Italy
| | - Giorgio Lo Iacono
- Department of Thoracic Surgery, IEO, European Institute of Oncology IRCCS, 20141 Milan, Italy
| | - Lorenzo Spaggiari
- Department of Thoracic Surgery, IEO, European Institute of Oncology IRCCS, 20141 Milan, Italy; Department of Oncology and Hemato-Oncology, University of Milan, 20122 Milan, Italy.
| | - Francesca De Lorenzi
- Department of Plastic and Reconstructive Surgery, European Institute of Oncology, IRCCS, 20141 Milan, Italy
| | - Valerio Cervelli
- Department of Plastic Surgery, University of Rome "Tor Vergata," Viale Oxford 81, Rome, Italy
| | - Mario Rietjens
- Department of Plastic and Reconstructive Surgery, European Institute of Oncology, IRCCS, 20141 Milan, Italy
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3
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Qin C, Xia Q, Chen Z, Zhou Q, Zheng X. En bloc resection of the recurrent pleural mesothelioma and reconstruction of the chest wall after immunotherapy: A case report. Thorac Cancer 2023; 14:3063-3066. [PMID: 37658846 PMCID: PMC10599967 DOI: 10.1111/1759-7714.15095] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2023] [Revised: 08/19/2023] [Accepted: 08/21/2023] [Indexed: 09/05/2023] Open
Abstract
Malignant pleural mesothelioma (MPM) is associated with previous asbestos exposure, while more clinical insights into this disease have come from other case studies. Maximal cytoreduction is critical in disease control and might help to improve the prognosis. Here, a 41-year-old female presented with a 6-month history of a mass detected in the chest wall following resection of a right pleural mesothelioma 2 years previously. A fluorodeoxyglucose positron emission tomography/computed tomography scan showed a right chest wall mass with a blurred boundary 8.9 cm × 3.7 cm in size. The patient had received one cycle of bevacizumab, carboplatin, and pemetrexed, and two cycles of nivolumab, ipilimumab, and gemcitabine 5 months before admission. We subsequently resected the tumor, the involved diaphragm, and the fifth and sixth ribs, and titanium mesh and continuous suture were used to close the thoracic cage. The fixed paraffin-embedded tissues showed epithelioid pleural mesothelioma. The patient received nivolumab and ipilimumab postoperatively, and no recurrence was detected 16 months after surgery. En bloc resection with reconstructive surgery effectively removed the locally advanced malignancy and restored the biological function of the thorax with a favorable prognosis. Neoadjuvant immunotherapy might therefore be conducive to radical resection and perioperative immunotherapy might improve the prognosis.
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Affiliation(s)
- Changlong Qin
- Lung Cancer Center, West China HospitalSichuan UniversityChengduPeople's Republic of China
- Lung Cancer Institute, West China Hospital, Sichuan UniversityChengduPeople's Republic of China
| | - Qinghong Xia
- Operating Room of Anesthesia Surgery Center, West China HospitalSichuan UniversityChengduPeople's Republic of China
- West China School of NursingSichuan UniversityChengduPeople's Republic of China
| | - Zi‐Jia Chen
- Lung Cancer Center, West China HospitalSichuan UniversityChengduPeople's Republic of China
- Lung Cancer Institute, West China Hospital, Sichuan UniversityChengduPeople's Republic of China
| | - Qinghua Zhou
- Lung Cancer Center, West China HospitalSichuan UniversityChengduPeople's Republic of China
- Lung Cancer Institute, West China Hospital, Sichuan UniversityChengduPeople's Republic of China
| | - Xi Zheng
- Lung Cancer Center, West China HospitalSichuan UniversityChengduPeople's Republic of China
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Khamitov K, Dudek W, Arkudas A, Haj Khalaf M, Parjiea C, Higaze M, Horch RE, Sirbu H. Interdisciplinary Treatment of Malignant Chest Wall Tumors. J Pers Med 2023; 13:1405. [PMID: 37763172 PMCID: PMC10532685 DOI: 10.3390/jpm13091405] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2023] [Revised: 09/15/2023] [Accepted: 09/18/2023] [Indexed: 09/29/2023] Open
Abstract
BACKGROUND Chest wall resections for malignant chest wall tumors (MCWTs), particularly those with full-thickness chest wall involvement requiring reconstruction, present a therapeutic challenge for thoracic and plastic reconstructive surgeons. The purpose of this study was to review our experience with chest wall resection for primary and metastatic MCWTs, with a focus on perioperative outcomes and postoperative overall survival (OS). METHODS All patients who underwent surgical resection for primary and secondary MCWTs at our single institution between 2000 and 2019 were retrospectively analyzed. RESULTS A total of 42 patients (25 male, median age 60 years) operated upon with curative (n = 37, 88.1%) or palliative (n = 5, 11.9%) intent were reviewed. Some 33 (78%) MCWTs were of secondary origin. Chest wall reconstruction was required in 40 (95%) cases. A total of 13 (31%) patients had postoperative complications and one (2.3%) died perioperatively. The 5-year postoperative overall survival rate was 51.9%. The postoperative 5-year survival rate of 42.6% in patients with secondary MCWTs was significantly lower compared to the figure of 87.5% in patients with primary MCWTs. CONCLUSIONS In well-selected patients, chest wall resections for primary and secondary MCWTs are feasible and associated with good perioperative outcomes. For secondary MCWTs, surgery can also be performed with palliative intent.
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Affiliation(s)
- Koblandy Khamitov
- Faculty of Medicine, Friedrich-Alexander-University Erlangen-Nürnberg, 91054 Erlangen, Germany
- Department of Thoracic Surgery, University Hospital Erlangen, Krankenhausstr. 12, 91054 Erlangen, Germany
| | - Wojciech Dudek
- Faculty of Medicine, Friedrich-Alexander-University Erlangen-Nürnberg, 91054 Erlangen, Germany
- Department of Thoracic Surgery, University Hospital Erlangen, Krankenhausstr. 12, 91054 Erlangen, Germany
| | - Andreas Arkudas
- Faculty of Medicine, Friedrich-Alexander-University Erlangen-Nürnberg, 91054 Erlangen, Germany
- Department of Plastic and Hand Surgery, University Hospital Erlangen, 91054 Erlangen, Germany
| | - Mohamed Haj Khalaf
- Faculty of Medicine, Friedrich-Alexander-University Erlangen-Nürnberg, 91054 Erlangen, Germany
- Department of Thoracic Surgery, University Hospital Erlangen, Krankenhausstr. 12, 91054 Erlangen, Germany
| | - Chirag Parjiea
- Faculty of Medicine, Friedrich-Alexander-University Erlangen-Nürnberg, 91054 Erlangen, Germany
- Department of Thoracic Surgery, University Hospital Erlangen, Krankenhausstr. 12, 91054 Erlangen, Germany
| | - Mostafa Higaze
- Faculty of Medicine, Friedrich-Alexander-University Erlangen-Nürnberg, 91054 Erlangen, Germany
- Department of Thoracic Surgery, University Hospital Erlangen, Krankenhausstr. 12, 91054 Erlangen, Germany
| | - Raymund E. Horch
- Faculty of Medicine, Friedrich-Alexander-University Erlangen-Nürnberg, 91054 Erlangen, Germany
- Department of Plastic and Hand Surgery, University Hospital Erlangen, 91054 Erlangen, Germany
| | - Horia Sirbu
- Faculty of Medicine, Friedrich-Alexander-University Erlangen-Nürnberg, 91054 Erlangen, Germany
- Department of Thoracic Surgery, University Hospital Erlangen, Krankenhausstr. 12, 91054 Erlangen, Germany
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Alshehri A. Chest wall osteochondroma resection with biologic acellular bovine dermal mesh reconstruction in pediatric hereditary multiple exostoses: A case report and review of literature. World J Clin Cases 2023; 11:4123-4132. [PMID: 37388792 PMCID: PMC10303597 DOI: 10.12998/wjcc.v11.i17.4123] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/22/2023] [Revised: 05/02/2023] [Accepted: 05/12/2023] [Indexed: 06/12/2023] Open
Abstract
BACKGROUND Hereditary multiple exostoses is a rare genetic disorder characterized by the growth of multiple osteochondromas affecting primarily long bones. Chest wall lesions may represent a challenge, particularly in pediatric patients. Pain is a common manifestation. However, life-threatening complications can result from direct involvement of adjacent structures. Surgical resection with appropriate reconstruction is often required.
CASE SUMMARY A 5-year-old male who was diagnosed with hereditary multiple exostoses presented with significant pain from a large growing chest wall exostosis lesion. After appropriate preoperative investigations, he underwent surgical resection with reconstruction of his chest wall using a biologic bovine dermal matrix mesh.
CONCLUSION Resection of chest wall lesions in children represents a challenge. Preoperative planning to determine the appropriate reconstruction strategy is essential.
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Affiliation(s)
- Abdullah Alshehri
- Department of Surgery, College of Medicine, King Saud University, Riyadh 11623, Saudi Arabia
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Chai CS, Shamugam K, Basiron NB, Zain MABM, Zainal HB, Luen KK, Sathiamurthy N, Chai DN, Pandian BDAR. Challenges in Complex Oncological Chest Wall Reconstruction with Free Anterolateral Thigh Flap and Titanium Rib Plate. Indian J Plast Surg 2023; 56:166-172. [PMID: 37153344 PMCID: PMC10159709 DOI: 10.1055/s-0043-1761177] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/25/2023] Open
Abstract
AbstractExtensive chest wall tumor resection and reconstruction possess a formidable challenge and require good collaboration between thoracic and reconstructive surgeons. In this article, we reviewed our experience in six consecutive cases requiring complex chest wall resection and reconstruction with titanium rib plates and free anterolateral thigh fasciocutaneous flap with fascia lata with a minimum 24 months follow-up postoperatively.Six patients with a mean age of 54 were diagnosed to have locally advanced malignant (n = 5) and benign (n = 1) tumors. They underwent wide local excision with a mean of six ribs resected, and the average size of the soft tissue defect was 389cm2. The integrity of the thoracic cage was restored by using titanium rib plates. Fascia lata was harvested along with free anterolateral thigh fasciocutaneous flap to achieve near airtight closure of pleural space for soft tissue coverage. Two patients required early flap exploration with successful flap salvage. One flap failure was reported on postoperative day 11 due to a mechanical cause and a redo surgery was required. With an average stay of 3 days in the intensive care unit, no perioperative pulmonary complications were recorded.Complex oncological chest wall resection and reconstruction with titanium rib plates and free anterolateral thigh fasciocutaneous flap with fascia lata yielded satisfactory aesthetic and physiological functional outcomes.
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Affiliation(s)
- Cheng Siew Chai
- Department of Plastic and Reconstructive Surgery, Hospital Kuala Lumpur, Jalan Pahang, Kuala Lumpur, Malaysia
| | - Kasthuri Shamugam
- Department of Plastic and Reconstructive Surgery, Hospital Kuala Lumpur, Jalan Pahang, Kuala Lumpur, Malaysia
| | - Normala Binti Basiron
- Department of Plastic and Reconstructive Surgery, Hospital Kuala Lumpur, Jalan Pahang, Kuala Lumpur, Malaysia
| | - Mohammad Ali Bin Mat Zain
- Department of Plastic and Reconstructive Surgery, Hospital Kuala Lumpur, Jalan Pahang, Kuala Lumpur, Malaysia
| | - Hamidah Binti Zainal
- Department of Plastic and Reconstructive Surgery, Hospital Kuala Lumpur, Jalan Pahang, Kuala Lumpur, Malaysia
| | - Koh Khai Luen
- Department of Plastic and Reconstructive Surgery, Hospital Kuala Lumpur, Jalan Pahang, Kuala Lumpur, Malaysia
| | - Narasimman Sathiamurthy
- Thoracic Surgery Unit, Department of General Surgery, Hospital Kuala Lumpur, Jalan Pahang, Kuala Lumpur, Malaysia
| | - Diong Nguk Chai
- Thoracic Surgery Unit, Department of General Surgery, Hospital Kuala Lumpur, Jalan Pahang, Kuala Lumpur, Malaysia
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7
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Goldsmith I, Dovgalski L, Evans PL. 3D Printing Technology for Chest Wall Reconstruction With a Sternum-Ribs-Cartilage Titanium Implant: From Ideation to Creation. INNOVATIONS-TECHNOLOGY AND TECHNIQUES IN CARDIOTHORACIC AND VASCULAR SURGERY 2023; 18:67-72. [PMID: 36803147 DOI: 10.1177/15569845231153632] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/22/2023]
Abstract
OBJECTIVE We describe the use of 3-dimensional (3D) printing technology to plan and reconstruct the sternum, adjoining cartilages, and ribs with a custom-made, anatomically designed, 3D-printed titanium implant for an isolated sternal metastasis complicated with a pathological fracture. METHODS We imported submillimeter slice computed tomography scan data into Mimics Medical 20.0 software and by manual bone threshold segmentation created a 3D virtual model of the patient's chest wall and tumor. For all-around tumor-free margins, we grew the tumor by 2 cm. The replacement implant was designed in 3D using the anatomical features of the sternum, cartilages, and ribs and manufactured using TiMG 1 powder fusion technology. Physiotherapy was provided prior to and following surgery, and the impact of reconstruction on pulmonary functions was assessed. RESULTS At surgery, the precise resection, clear margins, and a secure fit were achieved. At follow-up, there was no dislocation, paradoxical movement, change in performance status, or dyspnea. There was a decrease in forced expiratory volume in 1 s (FEV1) from 105% prior to surgery to 82% following surgery and in forced vital capacity (FVC) from 108% to 75%, with no difference in the FEV1/FVC ratio, suggesting a restrictive pattern of impairment. CONCLUSIONS With 3D printing technology, reconstructing a large anterior chest wall defect with a custom-made, anatomical, 3D-printed titanium alloy implant is feasible and safe, and it preserves the shape, structure, and function of the chest wall, albeit with a restrictive pattern of pulmonary function, which can be addressed with physiotherapy.
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Affiliation(s)
- Ira Goldsmith
- Department of Cardiothoracic Surgery, Morriston Hospital, Swansea, Wales, UK
| | - Lawrence Dovgalski
- Maxillofacial Laboratory Services, Morriston Hospital, Swansea, Wales, UK
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Zhang H, Hou B, Xia T, Ji L, Li J, Chen T, Shang G. Primary sternal tumour resection and reconstruction with LARS mesh-bone cement sandwich by 3D-printing: Case reports. Front Bioeng Biotechnol 2023; 11:1024480. [PMID: 37091347 PMCID: PMC10119393 DOI: 10.3389/fbioe.2023.1024480] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2022] [Accepted: 03/31/2023] [Indexed: 04/25/2023] Open
Abstract
Background: There are many reconstruction methods after sternal tumor resection, but the method that LARS mesh combines with bone-cement has not been reported. Case report: A 54-year-old female patient and a 55-year-old male patient admitted to our department all presented with sternum masses, but neither presented with respiratory disorders. In women with limited manubrium sternum lesions, we resected the manubrium sternum completely. In men with sternal lesions, we removed part of the sternum and part of the sternocostal joint. The patients recovered well after surgery, and there were no respiratory complications and no tumor recurrence during the 1-year follow-up respectively. Conclusion: We report two cases of sternal defect repair using LARS mesh combined with bone cement. This method is safe and stable, and can achieve satisfactory results.
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Affiliation(s)
- He Zhang
- Department of Bone and Soft Tissue Oncology, Department of Surgery, Shengjing Hospital, China Medical University, ShenYang, Liaoning, China
| | - Bo Hou
- Department of Bone and Soft Tissue Oncology, Department of Surgery, Shengjing Hospital, China Medical University, ShenYang, Liaoning, China
| | - Tienan Xia
- Department of Orthopedics, Fifth People’s Hospital of Shenyang, ShenYang, Liaoning, China
| | - Lu Ji
- Department of Gynecology and Obstetrics, Shengjing Hospital, China Medical University, ShenYang, Liaoning, China
| | - Jiatong Li
- Department of Bone and Soft Tissue Oncology, Department of Surgery, Shengjing Hospital, China Medical University, ShenYang, Liaoning, China
| | - Ting Chen
- Department of Bone and Soft Tissue Oncology, Department of Surgery, Shengjing Hospital, China Medical University, ShenYang, Liaoning, China
- *Correspondence: Ting Chen, ; Guanning Shang,
| | - Guanning Shang
- Department of Bone and Soft Tissue Oncology, Department of Surgery, Shengjing Hospital, China Medical University, ShenYang, Liaoning, China
- *Correspondence: Ting Chen, ; Guanning Shang,
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Chest-Wall Tumors and Surgical Techniques: State-of-the-Art and Our Institutional Experience. J Clin Med 2022; 11:jcm11195516. [PMID: 36233384 PMCID: PMC9573184 DOI: 10.3390/jcm11195516] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2022] [Revised: 09/16/2022] [Accepted: 09/17/2022] [Indexed: 11/16/2022] Open
Abstract
The chest wall can be involved in both primary and secondary tumors, and even today, their management and treatment continue to be a challenge for surgeons. Primary chest-wall tumors are relatively rare and include a large group of neoplasms that can arise from not only bone or cartilage of the chest wall but also from associated subcutaneous tissue from muscle and blood vessels. Secondary tumors refer to a direct invasion of the chest wall by neoplasms located elsewhere in the body, mainly metastases from breast cancer and lung cancer. En-bloc surgical excision of the lesion should ensure adequate negative margins to avoid local recurrence, and a full thickness surgical resection is often required, and it can result in important chest-wall defects such as skeletal instability or impaired breathing dynamics. The reconstruction of large defects of the chest wall can be complex and often requires the use of prosthetic and biologic mesh materials. This article aims to review the literature on these tumor entities, focusing on the main surgical techniques and the most recent advances in chest-wall resection and reconstruction. We also report on the institutional experience our center.
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10
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Chest Wall Reconstruction: A Comprehensive Analysis. CURRENT SURGERY REPORTS 2022. [DOI: 10.1007/s40137-022-00318-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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11
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Goldsmith I. Chest Wall Reconstruction With 3D Printing: Anatomical and Functional Considerations. INNOVATIONS-TECHNOLOGY AND TECHNIQUES IN CARDIOTHORACIC AND VASCULAR SURGERY 2022; 17:191-200. [PMID: 35699725 DOI: 10.1177/15569845221102138] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Large chest wall defects, as a result of wide local excision of chest wall pathology, require skeletal and soft-tissue reconstruction to restore the anatomical shape, structure, and respiratory function of the thorax. Reconstruction is challenging and requires the surgical reconstructive team to understand the anatomic and physiologic morbidity related to the defect and the choice of reconstructive techniques available to restore form and function. Rapidly emerging 3-dimensional (3D) printing technology allows the reconstructive surgical team to customize the therapeutic process of skeletal reconstruction by accurately mimicking the shape and structure of the chest wall being replaced. An integrated knowledge of the anatomy, physiology, mechanics of breathing, and respiratory tests is important to restore form and function. The focus of this article is to review the anatomy, physiology, and assessment of respiratory function from the classical textbooks and integrate this knowledge with the precise anatomy of the chest wall created by 3D printing technology. By doing so, this article will demonstrate how 3D printing may help the reconstructive team to understand the anatomic and physiologic morbidity related to the chest wall defect and the importance of taking each of these aspects into consideration when undertaking chest wall reconstruction of the thorax.
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Affiliation(s)
- Ira Goldsmith
- Department of Cardiothoracic Surgery, 97701Morriston Hospital, Swansea Bay University Health Board, Wales, UK
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12
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The Best of Chest Wall Reconstruction: Principles and Clinical Application for Complex Oncologic and Sternal Defects. Plast Reconstr Surg 2022; 149:547e-562e. [PMID: 35196698 DOI: 10.1097/prs.0000000000008882] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
LEARNING OBJECTIVES After studying this article, the participant should be able to: 1. Appraise and evaluate risk factors for respiratory compromise following oncologic resection. 2. Outline and apply an algorithmic approach to reconstruction of the chest wall based on defect composition, size, and characteristics of surrounding tissue. 3. Recognize and evaluate indications for and types of skeletal stabilization of the chest wall. 4. Critically consider, compare, and select pedicled and free flaps for chest wall reconstruction that do not impair residual respiratory function or skeletal stability. SUMMARY Chest wall reconstruction restores respiratory function, provides protection for underlying viscera, and supports the shoulder girdle. Common indications for chest wall reconstruction include neoplasms, trauma, infectious processes, and congenital defects. Loss of chest wall integrity can result in respiratory and cardiac compromise and upper extremity instability. Advances in reconstructive techniques have expanded the resectability of large complex oncologic tumors by safely and reliably restoring chest wall integrity in an immediate fashion with minimal or no secondary deficits. The purpose of this article is to provide the reader with current evidenced-based knowledge to optimize care of patients requiring chest wall reconstruction. This article discusses the evaluation and management of oncologic chest wall defects, reviews controversial considerations in chest wall reconstruction, and provides an algorithm for the reconstruction of complex chest wall defects. Respiratory preservation, semirigid stabilization, and longevity are key when reconstructing chest wall defects.
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Haslam M, Dentcheva E, Shafqat MS, Petrov R. Structural Failure of the BioBridge Rib Prosthesis After Chest Wall Resection. Ann Thorac Surg 2022; 114:e233-e235. [PMID: 35051400 DOI: 10.1016/j.athoracsur.2021.12.053] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/27/2021] [Revised: 12/02/2021] [Accepted: 12/18/2021] [Indexed: 11/17/2022]
Abstract
Chest wall reconstruction presents a challenging surgical problem with no universally recognized gold standard for the procedure. Various prosthetic and bioprosthetic materials exist for use in chest wall reconstruction, with bioprosthetic materials offering significant advantages in the case of a preoperatively infected surgical field. Here we present a case of the absorbable BioBridge system (Acute Innovations, Hillsboro, OR) used for chest well reconstruction and describe a novel complication of structural failure of the BioBridge plate, involving fracturing of the prosthesis with wound erosion, ultimately requiring reoperation and removal of the device.
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Affiliation(s)
- Miranda Haslam
- Department of General Surgery, Temple University Hospital, Philadelphia, Pennsylvania
| | - Eva Dentcheva
- Division of Plastic and Reconstructive Surgery, Department of Surgery, Temple University Hospital, Philadelphia, Pennsylvania
| | - M Shuja Shafqat
- Division of Plastic and Reconstructive Surgery, Department of Surgery, Temple University Hospital, Philadelphia, Pennsylvania; Division of Plastic and Reconstructive Surgery, Department of Surgical Oncology, Fox Chase Cancer Center, Philadelphia, Pennsylvania
| | - Roman Petrov
- Department of Thoracic Medicine and Surgery, Temple University Hospital, Philadelphia, Pennsylvania; Department of Surgical Oncology, Fox Chase Cancer Center, Philadelphia, Pennsylvania.
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Surgical Management and Reconstruction of Diaphragm, Pericardium and Chest Wall in Mesothelioma Surgery: A Review. J Clin Med 2021; 10:jcm10112330. [PMID: 34073544 PMCID: PMC8197912 DOI: 10.3390/jcm10112330] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2021] [Revised: 05/20/2021] [Accepted: 05/25/2021] [Indexed: 12/12/2022] Open
Abstract
Mesothelioma is an aggressive disease arising from parietal pleura. Surgery is a valuable option in the frame of a multimodality treatment. Several surgical approaches have been standardized with the aim of a macroscopic complete resection; these often require homolateral diaphragm and pericardial resection and reconstruction. Extrapleural pneumonectomy (EPP) and extended pleurectomy decortication (EPD) have been recognized as radical surgical procedures. Nevertheless, both operations are technically challenging and associated with a significant rate of peri-operative morbidity and non-negligible mortality. The diaphragmatic and pericardial reconstruction technique is mandatory to avoid respiratory impairment and to reduce post-operative complications like gastric and cardiac herniation. Moreover, in the case of localized chest wall recurrence, surgery might be considered a valuable therapeutical option for highly selected and fit patients. All the technical aspects of the resection and reconstruction of the diaphragm, pericardium, and chest wall are described as well as the possible use of new minimally invasive techniques. In addition, the choice of different prosthetic materials, considering the most recent innovations in the field, are discussed.
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15
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Prisciandaro E, Hustache-Castaing R, Michot A, Jougon J, Thumerel M. Chest wall resection and reconstruction for primary and metastatic sarcomas: an 11-year retrospective cohort study. Interact Cardiovasc Thorac Surg 2021; 32:744-752. [PMID: 33532842 DOI: 10.1093/icvts/ivab003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2020] [Revised: 12/05/2020] [Accepted: 12/12/2020] [Indexed: 11/12/2022] Open
Abstract
OBJECTIVES Chest wall sarcomas are rare, aggressive malignancies, the management of which mainly revolves around surgery. Radical tumour excision with free margins represents the optimal treatment for loco-regional clinically resectable disease. The objective of this study was to review our 11-year experience with chest wall resection for primary and metastatic sarcomas, focusing on surgical techniques and strategies for reconstruction. METHODS Retrospective analysis of a comprehensive database of patients who underwent chest wall resection for primary or secondary sarcoma at our Institute from January 2009 to December 2019. RESULTS Out of 26 patients, 21 (81%) suffered from primary chest wall sarcoma, while 5 (19%) had recurring disease. The median number of resected ribs was 3. Sternal resection was performed in 6 cases (23%). Prosthetic thoracic reconstruction was deemed necessary in 24 cases (92%). Tumour recurrence was observed in 15 patients (58%). The median overall survival was 73.6 months. Primary and secondary tumours showed comparable survival (P = 0.49). At univariate analysis, disease recurrence and infiltrated margins on pathological specimens were associated with poorer survival (P = 0.014 and 0.022, respectively). In patients with primary sarcoma, the median progression-free survival was 13.3 months. Associated visceral resections were significantly associated to postoperative complications (P = 0.02). CONCLUSIONS Chest wall resection followed by prosthetic reconstruction is feasible in carefully selected patients and should be performed by experienced surgeons with the aim of achieving free resection margins, resulting in improved long-term outcomes.
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Affiliation(s)
- Elena Prisciandaro
- Division of Thoracic Surgery, Centre Hospitalier Universitaire de Bordeaux, Pessac, France
| | - Romain Hustache-Castaing
- Division of Thoracic Surgery, Centre Hospitalier Universitaire de Bordeaux, Pessac, France.,Université de Bordeaux, Bordeaux, France
| | - Audrey Michot
- Division of Surgery, Bergonié Institute, Bordeaux, France
| | - Jacques Jougon
- Division of Thoracic Surgery, Centre Hospitalier Universitaire de Bordeaux, Pessac, France.,Université de Bordeaux, Bordeaux, France
| | - Matthieu Thumerel
- Division of Thoracic Surgery, Centre Hospitalier Universitaire de Bordeaux, Pessac, France.,Université de Bordeaux, Bordeaux, France
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16
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Zapata González RA, Montoya Medina C, Vélez Castaño PA, Bedoya Muñoz LJ. Reconstrucción de pared torácica con material de fijación en pacientes con lesiones tumorales. Serie de casos. REVISTA COLOMBIANA DE CIRUGÍA 2021. [DOI: 10.30944/20117582.545] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Introducción. El manejo quirúrgico de las lesiones de la pared costal con resección y reconstrucción con material protésico ha venido en aumento, debido al avance en las técnicas quirúrgicas y en la experiencia del cirujano, así como en la innovación y las características de los materiales protésicos, que permiten realizar resecciones amplias de la pared garantizando una mayor estabilidad esquelética, una menor alteración de la mecánica respiratoria y mejores los resultados estéticos.
Métodos. Se presenta la experiencia en la clínica CardioVID, Medellín, Colombia, entre los años 2015 y 2019, mediante una revisión retrospectiva de 8 casos sometidos a resección de lesiones benignas de la pared torácica y reconstrucción con material protésico.
Resultados. Se encontró una adecuada evolución de los pacientes, con un buen resultado estético y funcional, con adecuado control de la enfermedad, sin reportes de complicaciones ni de recidiva en el seguimiento.
Discusión. Una técnica adecuada permite la reconstrucción de estos defectos con complicaciones mínimas y bajas tasas de extracción de prótesis, finalizando con excelentes resultados funcionales y cosméticos.
Con nuestra experiencia podemos concluir que la elección adecuada de los pacientes candidatos a manejo quirúrgico, una buena técnica quirúrgica y un personal con experiencia son cruciales para lograr buenos resultados en cuanto a función pulmonar y estética. Además de lograr una sobrevida bajo los parámetros establecidos posterior a lograr una resección R0.
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17
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Alam NZ. Surgical Management of Chest Wall Sarcomas. Sarcoma 2021. [DOI: 10.1007/978-981-15-9414-4_17] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022] Open
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Fernández-Trujillo L, Sangiovanni S, Morales EI, Marin V, Sua LF, Velasquez M. Sternal cavernous hemangioma and reconstruction of the anterior chest wall: a case report. BMC Surg 2020; 20:288. [PMID: 33213427 PMCID: PMC7678184 DOI: 10.1186/s12893-020-00961-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2020] [Accepted: 11/12/2020] [Indexed: 12/20/2022] Open
Abstract
Background The sternum is considered an unusual tumor site, corresponding to 15% of all thoracic wall tumors. Primary sternal tumors are even rarer and most commonly malignant. We present the case of a young man who consulted with a painful sternal mass, which after its resection is confirmed to be a cavernous hemangioma. Case presentation A 39-year-old man, with unremarkable medical history besides a 2-year-long sternal pain, non-irradiated, which worsens over the last few months and is accompanied by the appearance of a sternal palpable mass. On physical exam, there was a bulging of the sternal manubrium, with no inflammatory changes. Thoracic CT scan shows an expansive and lytic lesion of the sternum, compromising the manubrium and extending to the third sternocostal joint, without intrathoracic compromise nor cleavage plane with mediastinal vascular structures. The patient is taken to resection of the mass and sternal reconstruction using prosthetic material and pectoral and fasciocutaneous muscular flaps. Histopathological findings: cavernous hemangioma with negative borders and no other malignant findings. Conclusions Sternal hemangiomas can cause defects in the bone structure and show an expansive growth, challenging the differentiation between a benign or malignant lesion. Therefore, they should be considered malignant until shown otherwise. Management involves radical surgery with curative purposes and posterior reconstruction to improve quality of life, as shown with our patient.
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Affiliation(s)
- Liliana Fernández-Trujillo
- Department of Internal Medicine, Pulmonology Service, Interventional Pulmonology, Fundación Valle del Lili, Avenida Simón Bolívar, Carrera 98 # 18-49, Tower 6, 4th Floor, Cali, 7600032, Colombia. .,Faculty of Health Sciences, Universidad Icesi, Calle 18 # 122-135, Cali, 7600032, Colombia.
| | - Saveria Sangiovanni
- Clinical Research Center, Fundación Valle del Lili, Carrera 98 # 18-49, Cali, 7600032, Colombia
| | - Eliana I Morales
- Faculty of Health Sciences, Universidad Icesi, Calle 18 # 122-135, Cali, 7600032, Colombia.,Department of Internal Medicine, Pulmonology Service, Fundación Valle del Lili, Carrera 98 # 18-49, Cali, 7600032, Colombia
| | - Valeria Marin
- Faculty and Postgraduate School of Dentistry, Universidad del Valle, Calle 4B # 36-00, Cali, Colombia.,Department of Innovation and Technology, HUMANBX S.A.S, Carrera 65 # 1A-93, Cali, Colombia
| | - Luz F Sua
- Faculty of Health Sciences, Universidad Icesi, Calle 18 # 122-135, Cali, 7600032, Colombia.,Department of Pathology and Laboratory Medicine, Fundación Valle del Lili, Carrera 98 # 18-49, Cali, 7600032, Colombia
| | - Mauricio Velasquez
- Faculty of Health Sciences, Universidad Icesi, Calle 18 # 122-135, Cali, 7600032, Colombia.,Department of Surgery, Thoracic Surgery Service, Fundación Valle del Lili, Carrera 98 # 18-49, Cali, 7600032, Colombia
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Girotti PNC, Königsrainer I, Pastorino U, Girotti AL, Rosa F. Optimal chest wall prosthesis: comparative study of mechanical and functional behaviour. Eur J Cardiothorac Surg 2020; 59:ezaa355. [PMID: 33188690 DOI: 10.1093/ejcts/ezaa355] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/11/2020] [Revised: 07/09/2020] [Accepted: 08/07/2020] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVES Chest wall resections are most commonly performed for tumours, infection, radiation necrosis and trauma. Defects in the anterior chest greater than 5 cm, posterior defects more than 10 cm or resection including more than 3 ribs, independently of the location, require skeletal prosthetic reconstruction. The aim of this paper was to evaluate the strength of prostheses that reproduced the normal human anatomy using different materials subjected to the most dangerous loading conditions. METHODS The biomechanical behaviours of different prosthetic materials under critical rib fracture conditions were analysed using the finite element method and then validated through mechanical testing of 3-dimensional polymethylmethacrylate ribs as a prosthesis reproducing the native anatomy of the human ribcage. RESULTS The prosthetic materials and the polymethylmethacrylate prosthesis were tested under 3 load conditions: sternal load (an anterior-posterior load applied at the third rib); lateral load (strength applied at the lateral arch of the fifth rib) and vertical load (vertical load applied at the first sternocostal junction) and showed the same results in terms of failures compared to the results from the finite element method model simulation (same location and number of fractures were detected). Although the displacement error between the finite element method and experimental test was up to 5% overall, no other microcracking was observed. CONCLUSIONS This experimental study demonstrated that all prosthetic materials currently available for human use show optimal mechanical behaviour in term of resistance and organ protection. Specifically, polymethylmethacrylate was a good candidate as a prosthetic material in term of lightness, resistance and prosthetic weight.
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Affiliation(s)
| | - Ingmar Königsrainer
- Department of General and Thoracic Surgery, Landeskrankenhaus Feldkirch, Feldkirch, Austria
| | - Ugo Pastorino
- Department of Thoracic Surgery, National Institute of Cancer, Milan, Italy
| | | | - Francesco Rosa
- Department of Mechanical Engineering, Politecnico di Milano, Milan, Italy
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20
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Chest wall reconstruction with an anatomically designed 3-D printed titanium ribs and hemi-sternum implant. 3D Print Med 2020; 6:26. [PMID: 32975713 PMCID: PMC7519505 DOI: 10.1186/s41205-020-00079-0] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2020] [Accepted: 09/18/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Chest wall resection following wide local excision for bone tumor results in a large defect. Reconstructing this defect is complex and requires skeletal and soft tissue reconstruction. We describe the reconstruction of a large skeletal defect with a three-dimensional (3-D) printed custom-made, anatomically designed, titanium alloy ribs and hemi-sternum implant. METHOD To design the implant manual bone threshold segmentation was performed to create a 3-D virtual model of the patient's chest and the tumor from sub-millimeter slice computed tomography (CT) scan data. We estimated the extent of resection needed to ensure tumor-free margins by growing the tumor by two cm all around.. We designed the implant using an anatomical image of the ribs and right hemi-sternum and then fabricated a 3D model of them in titanium metal using TiMG 1 powder bed fusion technology. At surgery the implant was slotted into the defect and sutured to the ribs laterally and hemi-sternum medially. RESULTS Histology confirmed clear all around microscopic margins. Following surgery and at 18 month follow up the patient was asymptomatic with preserved quality of life and described no pain, localized tenderness or breathlessness. There was no displacement or paradoxical movement of the implant. CONCLUSION Our techniques of CT segmentation, editing, computer aided design of the implant and fabrication using laser printing of a custom-made anatomical titanium alloy chest wall ribs and hemi-sternum for reconstruction is feasible, safe and provides a satisfactory result. Hence, a patient specific 3-D printed titanium chest wall implant is another useful adjunct to the surgical approach for reconstructing large chest wall defects whilst preserving the anatomical shape, structure and function of the thorax.
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21
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Abstract
Chest wall sarcoma is a rare and challenging pathology best managed by a multidisciplinary team experienced in the management of a multiple different pathologies. Knowledge of the management sequence is important for each sarcoma type in order to provide optimal treatment. Surgical resection of chest wall resections remains the primary treatment of disease isolated to the chest wall. Optimal margins of resection and reconstruction techniques have yet to be determined.
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22
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Brito ÍM, Teixeira S, Paupério G, Choupina M, Ribeiro M. Giant chondrosarcoma of the chest wall: a rare surgical challenge. AUTOPSY AND CASE REPORTS 2020; 10:e2020166. [PMID: 33344295 PMCID: PMC7703468 DOI: 10.4322/acr.2020.166] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
The chest wall chondrosarcoma (CWC) is a rare slowly growing primary tumor of the chest wall with an incidence of <0.5 per million person-years. We present the case of a giant CWC that caused a mass effect on the mediastinum, heart, and lung. Large tumors with thoracic structures compression may be life threatening, and its resection and subsequent chest wall reconstruction represent a significant multidisciplinary surgical challenge. In this case, despite the large tumor dimensions, the preoperative planning—sparing key reconstructive options without compromising the tumor resection—allowed a complete en bloc tumor excision of a grade III chondrosarcoma with negative histologic margins. Successful reconstruction of the large full-thickness chest wall defect, with a latissimus dorsi muscle flap and methyl methacrylate incorporated into a polypropylene mesh in a sandwich fashion, was accomplished. Patient recovery was uneventful with good functional and aesthetic outcomes, and no evidence of recurrence at 1.5 years follow-up. This case report illustrates the main clinical, radiological, and histologic features of a CWC while discussing the surgical goals and highlighting the principles for chest wall reconstruction following extensive resection of a large and rare entity.
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Affiliation(s)
- Íris M Brito
- Coimbra University Hospital Center, Department of Plastic Surgery and Burns Unit. Coimbra, Portugal
| | - Sérgio Teixeira
- São João Hospital Center, Department of Plastic, Reconstructive and Maxillo-Facial Surgery. Porto, Portugal
| | - Gonçalo Paupério
- Portuguese Institute of Oncology - Porto, Department of Thoracic Surgery. Porto, Portugal
| | - Miguel Choupina
- Portuguese Institute of Oncology - Porto, Department of Plastic and Reconstructive Surgery. Porto, Portugal
| | - Matilde Ribeiro
- Portuguese Institute of Oncology - Porto, Department of Plastic and Reconstructive Surgery. Porto, Portugal
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23
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Osteoradionecrosis of the Chest Wall. PLASTIC AND RECONSTRUCTIVE SURGERY-GLOBAL OPEN 2020; 8:e2665. [PMID: 32309104 PMCID: PMC7159944 DOI: 10.1097/gox.0000000000002665] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2019] [Accepted: 01/08/2020] [Indexed: 11/25/2022]
Abstract
We present the case of a 48-year-old woman with a chronic ulcer with bony erosion over the right chest wall who had undergone adjuvant chemoradiotherapy for right breast cancer 18 years previously. Preoperative computed tomography revealed a large soft tissue ulcerative lesion with bony destruction of the anterolateral aspect of the right fifth and sixth ribs. Biopsy showed no evidence of recurrent malignancy. En bloc resection including the necrotic ulcer and partial resection of the fourth to sixth ribs was performed, resulting in a chest wall defect that exposed the right diaphragm and the right, middle, and lower lobes of the lung. Synthetic mesh was used to reconstruct the rib defect and prevent paradoxical respiration. A pedicle transverse rectus abdominis musculocutaneous flap was used for soft tissue and skin reconstruction.
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Abstract
The optimal surgical reconstruction of chest wall defects especially in the context of posttraumatic, oncological and congenital etiologies has a large impact on the recovery of the patients. Regardless of the etiology, various complications, such as a generally impaired respiratory physiology in an unstable thorax or decreased pulmonary clearance associated with acute and chronic pulmonary infections, may impair the recovery of affected patients. The postoperative occurrence of an intrathoracic dead space may lead to a difficult to treat empyema. Each thoracic wall defect must be accurately assessed and treated according to size, depth and location on the chest. The complexity of this condition and the resulting complications require the highest degree of surgical care which should be interdisciplinary both preoperatively and postoperatively.
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Affiliation(s)
- M Heldwein
- Klinik für Herz und Thoraxchirurgie, Uniklinik Köln, Universität zu Köln, Kerpener Str. 62, 50937, Köln, Deutschland
| | - F Doerr
- Klinik für Herz und Thoraxchirurgie, Uniklinik Köln, Universität zu Köln, Kerpener Str. 62, 50937, Köln, Deutschland
| | - G Schlachtenberger
- Klinik für Herz und Thoraxchirurgie, Uniklinik Köln, Universität zu Köln, Kerpener Str. 62, 50937, Köln, Deutschland
| | - K Hekmat
- Klinik für Herz und Thoraxchirurgie, Uniklinik Köln, Universität zu Köln, Kerpener Str. 62, 50937, Köln, Deutschland.
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Wang B, Guo Y, Tang J, Yu F. Three-dimensional custom-made carbon-fiber prosthesis for sternal reconstruction after sarcoma resection. Thorac Cancer 2019; 10:1500-1502. [PMID: 31094079 PMCID: PMC6558465 DOI: 10.1111/1759-7714.13084] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2019] [Revised: 04/08/2019] [Accepted: 04/11/2019] [Indexed: 01/23/2023] Open
Abstract
Radical resection is the preferred therapy for primary malignant sternal tumors. Sternal reconstruction is required to guarantee the best preservation of respiratory mechanics, and adequate mediastinal protection and acceptable cosmetic results after extensive tumor resection. A wide variety of methods and materials have been described for sternal reconstruction. Titanium implants are preferred by many surgeons because of their optimal features. However, the smooth surface of the metal prostheses does not facilitate the inward growth of the tissue, and the high density of metal can block the X‐ray and cause adverse effects on postoperative imaging and radiotherapy. Therefore, in this article we present a case of sternal reconstruction by means of a three dimensional (3D) custom‐made carbon‐fiber prosthesis following extensive resection of a sternal synovial sarcoma. The microporous structure on the surface of the carbon fiber composite material facilitates the inward growth of the tissue. Low density (1.5 g/cm3) of carbon‐fiber implant will not block the X‐ray and eliminates the adverse effects caused by metal material of postoperative imaging and radiotherapy. The 3D custom‐made carbon‐fiber prosthesis matched the thoracic defect perfectly and the chest wall reconstruction was stable for more than 24 months.
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Affiliation(s)
- Bin Wang
- Department of Thoracic Surgery, The Second Xiangya Hospital of Central South University, Hunan, China
| | - Yuanwei Guo
- Center for Clinical Pathology, Affiliated the First People's Hospital of Chenzhou, University of South China, Hunan, China
| | - Jingqun Tang
- Department of Thoracic Surgery, The Second Xiangya Hospital of Central South University, Hunan, China
| | - Fenglei Yu
- Department of Thoracic Surgery, The Second Xiangya Hospital of Central South University, Hunan, China
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Abstract
Pediatric chest wall tumors are rare. Malignancies predominate of which sarcomas are the most common. Their resection and the subsequent reconstruction of the chest wall has been a surgical challenge since Dr. Frederick W. Parham published his first comprehensive account on the subject in 1898. Chest wall reconstruction is age, site and pathology dependent, must preserve long term function and cosmesis, must accommodate future growth and development, and must not be a hindrance to adjuvant radiotherapy. Bony reconstruction can be relatively simple or complex involving combinations of synthetic meshes, bioprosthetic materials, steel or titanium constructs, autografts, homografts and porcine or bovine xenografts. Soft tissue coverage can be achieved with direct closure, skin grafts, local advancement flaps, pedicled or free myocutaneous or osseomyocutaneous flaps or a combination of these. Complications to be avoided include scoliosis, pain and activity restriction, restrictive pulmonary deficits and interference with adjuvant radiotherapy which may result in tumor recurrence. Advances in cancer therapy have improved short- and long-term survival but significant functional and cosmetic challenges remain particularly for large chest wall defects in the very young. The future may lie with absorbable semi-rigid meshes, biointegratable acellular homografts and xenografts, demineralized bone matrices and bone marrow stromal cells, the patient's own lab-grown stem-cell based vascularized osseomyocutaneous chest wall grafts or the obsolescence of surgical resection altogether in the age of targeted anti-tumor and immune based therapy.
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Affiliation(s)
- Gideon Sandler
- Pediatric Surgical Oncology, The University of Texas MD Anderson Cancer Center, 1400 Pressler Street 17.6053, External Mail: Unit 1484, Houston, TX 77030, United States of America.
| | - Andrea Hayes-Jordan
- Pediatric Surgical Oncology, The University of Texas MD Anderson Cancer Center, 1400 Pressler Street 17.6053, External Mail: Unit 1484, Houston, TX 77030, United States of America.
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D'Amico G, Manfredi R, Nita G, Poletti P, Milesi L, Livraghi L, Poletti E, Verga M, Robotti E, Ansaloni L. Reconstruction of the Thoracic Wall With Biologic Mesh After Resection for Chest Wall Tumors: A Presentation of a Case Series and Original Technique. Surg Innov 2017; 25:28-36. [PMID: 29251555 DOI: 10.1177/1553350617745954] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
Abstract
INTRODUCTION Synthetic materials have traditionally been used for tissue reconstruction in thoracic surgery. New biomaterials have been tested in other areas of surgery with good results. Non-cross-linked swine dermal collagen prosthesis has been used to reconstruct musculofascial defects in the trunk with low infection and herniation rate. MATERIAL AND METHODS Retrospectively, we analyze our initial experience of chest wall reconstruction on large defects using a non-cross-linked swine dermal collagen matrix mesh with a thickness of 1.4 mm. A total of 11 consecutive patients were included. Preoperative, intraoperative, and postoperative data were taken into consideration. RESULTS Eleven sarcoma patients with a mean age of 58.25 ± 12.9 years underwent chest wall resections. Complete thoracic wall defects ranged from 6 · 9 to 16 · 25 cm in size. In all cases, we used a porcine collagen matrix mesh, and in all patients, it was covered by transposition of myocutaneous flap. The complications occurred in 5 (45%) patients, 1 (9%) pneumonia, 1 atrial fibrillation (9%), and 3 (27%) wound healing difficulty because of hematoma or infection. There was no respiratory impairment, and the pulmonary function (total lung capacity, vital capacity, and forced expiratory volume in 1 second) was not statistically different before and after surgery. The 30-day mortality was 0%, 1-year mortality and 2-year mortality was 27.2%. The collagen material resulted in a durable and good to excellent chest wall stability in clinical follow-ups, and on computer tomography scans spanning over 2 years. CONCLUSION Non-cross-linked acellular porcine dermal collagen matrix is a feasible and reliable biological patch material for reconstruction of the thoracic wall. Excellent wound healing, long-term stability, low complication, and good pulmonary function are achieved even in large defects.
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28
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Reconstruction of the anterior chest wall with a 3-dimensionally printed biodynamic prosthesis. J Thorac Cardiovasc Surg 2017; 155:e59-e60. [PMID: 28986038 DOI: 10.1016/j.jtcvs.2017.08.118] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/07/2017] [Revised: 08/04/2017] [Accepted: 08/27/2017] [Indexed: 11/20/2022]
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