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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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Wojtyś ME, Kordykiewicz D, Wójcik J, Tomos P, Kostopanagiotou K. Consultations for Poland Syndrome: The Essentials for a Thoracic Surgeon. MEDICINA (KAUNAS, LITHUANIA) 2024; 60:1178. [PMID: 39064607 PMCID: PMC11278914 DOI: 10.3390/medicina60071178] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/29/2024] [Revised: 07/16/2024] [Accepted: 07/18/2024] [Indexed: 07/28/2024]
Abstract
Poland syndrome (PS) is a rare congenital musculoskeletal entity occurring in approximately 1 in 30,000 newborns that manifests with variable symbrachydactyly, ipsilateral costochondral deformities, an absence of pectoral muscles, and breast underdevelopment. These have potential impacts on social, somatic, and psychological functionality, often leading affected individuals to seek expert opinions on corrective surgery. Due to phenotypic variability, strict management guidelines are lacking, with treatment decisions often based on the specialist's personal experience rather than published evidence. Comprehensive imaging with CT and MRI with 3D reconstruction is crucial for providing a descriptive assessment of musculoskeletal defects. Management is multidisciplinary, involving thoracic, plastic, and pediatric surgeons and hand surgery specialists, as well as psychologists and developmental growth specialists. Surgery should achieve both structural and cosmetic correction to reverse the psychological and social impact and achieve patient satisfaction. We aim to provide thoracic surgeons the essential answers for sharing with affected adult individuals during consultations focusing on chest surgical correction.
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Affiliation(s)
- Małgorzata Edyta Wojtyś
- Department of Thoracic Surgery and Transplantation, Pomeranian Medical University in Szczecin, Alfreda Sokołowskiego 11, 70-891 Szczecin, Poland
| | - Dawid Kordykiewicz
- Department of Thoracic Surgery and Transplantation, Pomeranian Medical University in Szczecin, Alfreda Sokołowskiego 11, 70-891 Szczecin, Poland
| | - Janusz Wójcik
- Department of Thoracic Surgery and Transplantation, Pomeranian Medical University in Szczecin, Alfreda Sokołowskiego 11, 70-891 Szczecin, Poland
| | - Periklis Tomos
- Department of Thoracic Surgery, “Attikon” University Hospital of Athens, 12462 Athens, Greece
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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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Hashemi ASA, Gimenez A, Yim N, Bay C, Grush AE, Heinle JS, Buchanan EP. Anterior Chest Wall Reconstruction After Separation of Thoraco-Omphalopagus Conjoined Twins With Cadaveric Rib Grafts and Omental Flap. Ann Plast Surg 2023; 91:753-757. [PMID: 38079320 DOI: 10.1097/sap.0000000000003645] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2023]
Abstract
BACKGROUND Anterior chest wall defects have a wide range of etiologies in the pediatric population, ranging from infection, tumor, and trauma to congenital diseases. The reconstructive goals include restoring skeletal stability, obliterating dead space, preserving cardiopulmonary mechanics, and protecting vital underlying mediastinal organs. Although various reconstructive methods have been described in the literature, selecting the optimal method is challenging for the growing pediatric skeleton. Here, we report a case of previously thoraco-omphalopagus twins who underwent successful separation and reconstruction and presented for definitive anterior chest wall reconstruction. METHODS A pair of previously thoraco-omphalopagus conjoined twins underwent definitive anterior chest wall defect reconstruction using cadaveric ribs and omental flap. Twin A received 2 cadaveric ribs, whereas twin B had a much larger sternal defect that required 3 cadaveric ribs combined with an omental flap for soft tissue chest coverage. Both twins were followed up for 8 months. RESULTS Twin A's postoperative course was uneventful, and she was discharged on postoperative day 6. Twin B's course was complicated, and she was discharged on supported ventilation on postoperative day 10. At 8 months postoperatively, both twins healed well, and chest radiographs confirmed the stability of the chest reconstructions. The rib grafts in the twin with a tracheostomy were not mobile, and the patient had a solid sternum with adequate pulmonary expansion. The construct initially did not facilitate pulmonary functioning, but after a healing process, it eventually allowed for the twin with the tracheostomy who required pulmonary assistance to no longer need this device. CONCLUSIONS Cryopreserved cadaveric ribs and omental flaps offer safe and reliable reconstructive methods to successfully reconstruct congenital anterior chest wall skeletal defects in the growing pediatric population. The involvement of multidisciplinary team care is key to optimizing the outcomes.
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Affiliation(s)
| | - Alejandro Gimenez
- From the Division of Plastic Surgery, Michael E. DeBakey Department of Surgery, Baylor College of Medicine
| | | | - Caroline Bay
- From the Division of Plastic Surgery, Michael E. DeBakey Department of Surgery, Baylor College of Medicine
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Duranti L, Tavecchio L. New perspectives in prosthetic reconstruction in chest wall resection. Updates Surg 2023:10.1007/s13304-023-01562-z. [PMID: 37402065 DOI: 10.1007/s13304-023-01562-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2023] [Accepted: 06/03/2023] [Indexed: 07/05/2023]
Abstract
The extension of chest wall resection for the treatment of primary and secondary tumours is still widely debated. The reconstructive strategy after extensive surgery is challenging as well as chest wall demolition itself. Reconstructive surgery aims to avoid respiratory failure and to guarantee intra-thoracic organs protection. The purpose of this review is to analyse the literature on this issue focusing on the planning strategy for chest wall reconstruction. This is a narrative review, reporting data from the most interesting studies on chest wall demolition and reconstruction. Representative surgical series on chest wall thoracic surgery were selected and described. We focused to identify the best reconstructive strategies analyzing employed materials, techniques of reconstruction, morbidity and mortality. Nowadays the new "bio-mimetic" materials in "rigid" and "non-rigid" chest wall systems reconstructive represent new horizons for the treatment of challenging thoracic diseases. Further prospective studies are warranted to identify new materials enhancing thoracic function after major thoracic excisions.
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Affiliation(s)
- Leonardo Duranti
- Thoracic Surgey Unit, Fondazione IRCCS Istituto Nazionale dei Tumori di Milano, Via G Venezian 1, 20133, Milano, Italy.
| | - Luca Tavecchio
- Thoracic Surgey Unit, Fondazione IRCCS Istituto Nazionale dei Tumori di Milano, Via G Venezian 1, 20133, Milano, Italy
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Custom 3D-printed Titanium Implant for Reconstruction of a Composite Chest and Abdominal Wall Defect. PLASTIC AND RECONSTRUCTIVE SURGERY-GLOBAL OPEN 2021; 9:e3885. [PMID: 34858771 PMCID: PMC8631384 DOI: 10.1097/gox.0000000000003885] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2021] [Accepted: 08/19/2021] [Indexed: 11/26/2022]
Abstract
Background Three-dimensional (3D) printing of implantable materials is a recent technological advance that is available for clinical application. The most common medical application of 3D printing in plastic surgery is in the field of craniomaxillofacial surgery. There have been few applications of this technology in other areas. Methods Here, we discuss a case of a large, symptomatic composite thoracic and abdominal defect resulting from the resection of a chondrosarcoma of the costal marginand sections of the abdominal wall, diaphragm, and sternum. The initial and second attempts at reconstruction failed, resulting in a massive hernia. Given the size of the defect, the contiguity with a large abdominal wall defect, and the high risk of recurrence, a rigid thoracic reconstruction was essential to durably repair the thoracic hernia and serve as a scaffold to which both the diaphragm and the abdominal mesh could be secured. A custom-made plate offered the most durable and anatomically accurate reconstruction in this particular clinical scenario. This technology was used in concert with a single section of coated mesh for reconstruction of the diaphragm, chest wall, and abdominal wall. Results There were no post-operative complications. The patient has improvement of his symptoms and increased functional capacity. There is no evidence of hernia recurrence 1.5 years after repair. Conclusions 3D printing technology proved to be a useful and effective application for reconstruction of this large thoracic defect involving the costal margin. It is an available technology that should be considered for reconstruction of rigid structures with defect-specific precision.
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Song D, Li J, Pafitanis G, Li Z. Bilateral Anterolateral Thigh Myocutaneous Flaps for Giant Complex Chest Wall Reconstruction. Ann Plast Surg 2021; 87:298-309. [PMID: 34397518 DOI: 10.1097/sap.0000000000002860] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Extensive reconstruction of complex full-thickness chest wall oncological defects is challenging. Bilateral free anterolateral thigh (ALT) myocutaneous flap transfer for the complex reconstruction of a large area of the chest wall is discussed. MATERIALS AND METHODS We reported a single unit's experience in 1-staged multilayered reconstruction of large full-thickness chest wall defects in 22 patients (16 primary chest wall tumor cases, 5 locally advanced breast cancer cases, and 1 osteoradionecrosis case) treated between 2011 and 2018. Bilateral ALT myocutaneous flaps together with traditional cement implant or unmovable/movable joint conformable titanium struts were used for chest wall reconstruction. The anatomical characteristics of pedicle origin and pattern of the venae comitantes of the ALT myocutaneous flap, recipient vessels, and anastomosis patterns were described. RESULTS Bilateral ALT myocutaneous flaps were used for soft tissue reconstruction in 22 cases. Different methods of flap harvesting and vascular anastomosis were selected as needed. No vein grafts or arteriovenous loops were required. We observed 3 vascular patterns of the flap pedicle, including 1 oblique branch and descending branch (59.1%, n = 26), 2 single descending branch (9.1%, n = 4), and 3 double branches of the descending branch (31.8%, n = 14). The flap was harvested pedicled with solely the oblique branch in 7 (15.9%) cases, solely the descending branch in 28 (63.6%) cases to minimize the donor site morbidity, and pedicled with the oblique and descending branch in 9 (20.5%) cases to achieve multiple vascular anastomosis choices. Stable skeletal reconstructions were achieved using traditional cement implant (13.6%, n = 3) or conformable titanium struts (86.4%, n = 19), with good fixation strength. Complication risk was low. An algorithmic approach to management is presented and recommended. CONCLUSION Various forms of bilateral ALT myocutaneous flap transfer with different skeletal reconstruction presents as a reliable treatment for patients with large full-thickness chest wall defects. Anatomical variations in the pedicle and pattern of venae comitantes of the ALT myocutaneous flap are reported. In some challenging cases, finding the vessels in the recipient area is difficult. The clinical significance of each vascular pattern is delineated, and surgical technical considerations are discussed on the basis of the recipient area requirements and types of a flap's vascular anatomy.
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Affiliation(s)
- Dajiang Song
- From the Department of Oncology Plastic Surgery, Hunan Province Cancer Hospital and The Affiliated Cancer Hospital of Xiangya School of Medicine, Central South University, Changsha, Hunan
| | - Juanjuan Li
- Department of Breast and Thyroid Surgery, Renmin Hospital of Wuhan University, Wuhan, Hubei, China
| | - Georgios Pafitanis
- Department of Plastic Surgery and Reconstructive, Emergency Care and Trauma Division (ECAT), The Royal London Hospital, Barts Health NHS Trust & The Blizard Institute, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, UK
| | - Zan Li
- From the Department of Oncology Plastic Surgery, Hunan Province Cancer Hospital and The Affiliated Cancer Hospital of Xiangya School of Medicine, Central South University, Changsha, Hunan
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Weksler B. Commentary: Three-dimensional printing and customizable implants: The future is now. JTCVS Tech 2021; 8:216-217. [PMID: 34401859 PMCID: PMC8350870 DOI: 10.1016/j.xjtc.2021.05.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2021] [Revised: 05/10/2021] [Accepted: 05/11/2021] [Indexed: 11/25/2022] Open
Affiliation(s)
- Benny Weksler
- Division of Thoracic and Esophageal Surgery, Department of Thoracic and Cardiovascular Surgery, Allegheny General Hospital, Pittsburgh, Pa
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Vasudevan S, Vaidya S, S RB, C AB, N AY, Nagireddy SR. Temporary Extrathoracic Vacuum Therapy Splint in Chest Wall Reconstruction. Indian J Plast Surg 2021; 54:211-214. [PMID: 34239247 PMCID: PMC8257296 DOI: 10.1055/s-0041-1729502] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Background
Paradoxical respiration is a sinister consequence of bony chest cage defects which can persist even post chest wall reconstruction. It leads to prolonged dependence on mechanical ventilation postoperatively, thereby delaying recovery.
Methods
Negative pressure wound therapy (NPWT) was applied in early postoperative period to a patient with chest wall defect reconstructed with folded prolene mesh and free anterolateral thigh flap. Arterial blood gas (ABG), fraction of inspired oxygen (FiO
2
), peak end expiratory pressure (PEEP), oxygen saturation (SpO
2
), and blood pressure (BP) readings pre and post NPWT application were compared.
Results
There was marked improvement in the breathing mechanics and related parameters post NPWT application over the flap.
Conclusions
Negative extrathoracic pressure in the form of a temporary splint can enable early weaning off the ventilator and a smoother postoperative recovery in reconstructed chest wall defects.
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Affiliation(s)
- Srikanth Vasudevan
- Department of Plastic and Reconstructive Surgery, Manipal Hospital, Bangalore, India
| | - Shriram Vaidya
- Department of Critical Care Medicine, Manipal Hospital, Bangalore, India
| | - Ritu Baath S
- Department of Plastic and Reconstructive Surgery, Manipal Hospital, Bangalore, India
| | - Ashok Basur C
- Department of Plastic and Reconstructive Surgery, Manipal Hospital, Bangalore, India
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Abstract
Reconstruction of soft tissue defects following tumor ablation procedures in the trunk and extremities can challenge the microsurgeon. The goal is not just to provide adequate soft tissue coverage but also to restore form and function and minimize donor site morbidity. Although the principles of the reconstructive ladder still apply in the trunk and extremities, free tissue transfer is used in many cases to optimally restore form and function. Microsurgery has changed the practice in soft tissue tumors, and amputation is less frequently necessary.
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Reconstruction of large chest wall defects using three-dimensional custom-made implant technology. TURK GOGUS KALP DAMAR CERRAHISI DERGISI-TURKISH JOURNAL OF THORACIC AND CARDIOVASCULAR SURGERY 2021; 29:122-125. [PMID: 33768992 PMCID: PMC7970076 DOI: 10.5606/tgkdc.dergisi.2021.19385] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/22/2020] [Accepted: 03/11/2020] [Indexed: 11/21/2022]
Abstract
It is a challenging issue for thoracic surgeons to repair and reconstruct large defects after chest wall resection without disturbing pulmonary functions. Currently, it is possible to produce nearly the same prosthesis anatomically as the original with the three-dimensional printer technology. Titanium-alloy prostheses produced with the three-dimensional prototyping technology by selective laser sintering technique meet the sensitive needs of reconstruction without impairing the functionality of the tissue. This custom-made titanium prostheses can be used for this purpose safely and effectively as a good alternative.
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Kinoglou G, Vandeweyer E, Lothaire P, Gebhart M, Andry G. Thyroid Carcinoma Metastasis to the Sternum: Resection and Reconstruction. Acta Chir Belg 2020. [DOI: 10.1080/00015458.2001.12098629] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Affiliation(s)
- G. Kinoglou
- Head and Neck Surgery Department, Jules Bordet Cancer Institute, Rue Héger-Bordet 1, B-1000 Bruxelles, Belgium
| | - E. Vandeweyer
- Plastic Surgery Department, Jules Bordet Cancer Institute, Rue Héger-Bordet 1, B-1000 Bruxelles, Belgium
| | - P. Lothaire
- Head and Neck Surgery Department, Jules Bordet Cancer Institute, Rue Héger-Bordet 1, B-1000 Bruxelles, Belgium
| | - M. Gebhart
- Orthopedic Surgery Department, Jules Bordet Cancer Institute, Rue Héger-Bordet 1, B-1000 Bruxelles, Belgium
| | - G. Andry
- Head and Neck Surgery Department, Jules Bordet Cancer Institute, Rue Héger-Bordet 1, B-1000 Bruxelles, Belgium
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Mericli AF, Murariu D, Nemir S, Rhines LD, Walsh G, Adelman DM, Baumann DP, Butler CE. Soft-Tissue Reconstruction after Composite Vertebrectomy and Chest Wall Resection for Spinal Tumors. Plast Reconstr Surg 2020; 145:1275-1286. [PMID: 32332552 DOI: 10.1097/prs.0000000000006792] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Oncologic resections involving both the spine and chest wall commonly require immediate soft-tissue reconstruction. The authors hypothesized that reconstructions of composite resections involving both the thoracic spine and chest wall would have a higher complication rate than reconstructions for resections limited to the thoracic spine alone. METHODS The authors performed a retrospective analysis of all consecutive patients who underwent a thoracic vertebrectomy and soft-tissue reconstruction from 2002 to 2017. Patients were divided into two groups: those whose defect was limited to the thoracic spine and those who required a composite resection involving the chest wall. RESULTS One hundred patients were included. Composite resection patients had larger defects, as indicated by a greater incidence of multilevel vertebrectomies (70.2 percent versus 17 percent; p = 0.001). Thoracic spine patients were older (58.2 ± 10.4 years versus 48.6 ± 13.9 years; p < 0.001) and had a greater incidence of metastatic disease (88.7 percent versus 38.3 percent; p = 0.001). Univariate and multivariate logistic regression analyses demonstrated that composite resections were not significantly associated with a higher rate of surgical, medical, or overall complications. Multivariate logistic regression analysis of composite resection subgroup demonstrated that flap separation of the spinal cord from the intrapleural space was protective against complications (OR, 0.22; 95 percent CI, 0.05 to 0.81; p = 0.03). CONCLUSIONS Despite the large defect size in composite resection patients, there was no increase in complications compared to thoracic spine patients. In composite resection patients, separating the exposed spinal cord from the intrapleural space with well-vascularized soft tissue was protective against complications. CLINICAL QUESTION/LEVEL OF EVIDENCE Risk, II.
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Affiliation(s)
- Alexander F Mericli
- From the Departments of Plastic Surgery, Neurosurgery, and Thoracic Surgery, University of Texas M. D. Anderson Cancer Center; and the Department of Surgery, Division of Plastic Surgery, Allegheny General Hospital
| | - Daniel Murariu
- From the Departments of Plastic Surgery, Neurosurgery, and Thoracic Surgery, University of Texas M. D. Anderson Cancer Center; and the Department of Surgery, Division of Plastic Surgery, Allegheny General Hospital
| | - Stephanie Nemir
- From the Departments of Plastic Surgery, Neurosurgery, and Thoracic Surgery, University of Texas M. D. Anderson Cancer Center; and the Department of Surgery, Division of Plastic Surgery, Allegheny General Hospital
| | - Laurence D Rhines
- From the Departments of Plastic Surgery, Neurosurgery, and Thoracic Surgery, University of Texas M. D. Anderson Cancer Center; and the Department of Surgery, Division of Plastic Surgery, Allegheny General Hospital
| | - Garrett Walsh
- From the Departments of Plastic Surgery, Neurosurgery, and Thoracic Surgery, University of Texas M. D. Anderson Cancer Center; and the Department of Surgery, Division of Plastic Surgery, Allegheny General Hospital
| | - David M Adelman
- From the Departments of Plastic Surgery, Neurosurgery, and Thoracic Surgery, University of Texas M. D. Anderson Cancer Center; and the Department of Surgery, Division of Plastic Surgery, Allegheny General Hospital
| | - Donald P Baumann
- From the Departments of Plastic Surgery, Neurosurgery, and Thoracic Surgery, University of Texas M. D. Anderson Cancer Center; and the Department of Surgery, Division of Plastic Surgery, Allegheny General Hospital
| | - Charles E Butler
- From the Departments of Plastic Surgery, Neurosurgery, and Thoracic Surgery, University of Texas M. D. Anderson Cancer Center; and the Department of Surgery, Division of Plastic Surgery, Allegheny General Hospital
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Corkum JP, Garvey PB, Baumann DP, Abraham J, Liu J, Hofstetter W, Butler CE, Clemens MW. Reconstruction of massive chest wall defects: A 20-year experience. J Plast Reconstr Aesthet Surg 2020; 73:1091-1098. [PMID: 32269009 DOI: 10.1016/j.bjps.2020.02.010] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2019] [Revised: 10/22/2019] [Accepted: 02/12/2020] [Indexed: 10/25/2022]
Abstract
BACKGROUND Large chest wall resections can result in paradoxical chest wall movement leading to prolonged ventilator dependence and major respiratory impairment. The purpose of this study was to determine as to which factors are predictive or protective of complications in massive oncologic chest wall defect reconstructions. METHODS A retrospective review of a prospectively maintained database of consecutive patients who underwent immediate reconstruction of massive thoracic oncologic defects (≥5 ribs) was performed. Univariate and multivariate logistic regression analyses identified risk factors. RESULTS We identified 59 patients (median age, 53 years) with a mean follow-up of 36 months. Rib resections ranged from 5 to 10 ribs (defect area, 80-690 cm2). Sixty-two percent of the patients developed at least one postoperative complication. Superior/middle resections were associated with increased risk of general and pulmonary complications (71.4% vs. 35.3%; OR 4.54; p = 0.013). The 90-day mortality rate following massive chest wall resection and reconstruction was 8.5%. Two factors that were significantly associated with shorter overall survival time were preoperative XRT and preoperative chemotherapy (p = 0.021 and p < 0.001, respectively). CONCLUSIONS Patients with massive oncological thoracic defects have a high rate of reconstructive complications, particularly pulmonary, leading to prolonged ventilator dependence. Superior resections were more likely to be associated with increased pulmonary and overall complications. The length of postoperative recovery was significantly associated with the size of the defect, and larger defects had prolonged hospital stays. Because of the large dimensions of chest wall defects, almost half of the cases required flap coverage to allow for appropriate defect closure. Understanding the unique demands of these rare but challenging cases is critically important in predicting patient outcomes.
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Affiliation(s)
- Joseph P Corkum
- The Division of Plastic Surgery, Dalhousie University, Nova Scotia, Canada
| | - Patrick B Garvey
- Department of Plastic Surgery, MD Anderson Cancer Center, University of Texas, Houston, Texas, USA
| | - Donald P Baumann
- Department of Plastic Surgery, MD Anderson Cancer Center, University of Texas, Houston, Texas, USA
| | - Jasson Abraham
- The University of Texas Medical School at Houston, Houston, Texas, USA
| | - Jun Liu
- Department of Plastic Surgery, MD Anderson Cancer Center, University of Texas, Houston, Texas, USA
| | - Wayne Hofstetter
- Department of Thoracic Surgery, MD Anderson Cancer Center, University of Texas, Houston, Texas, USA
| | - Charles E Butler
- Department of Plastic Surgery, MD Anderson Cancer Center, University of Texas, Houston, Texas, USA
| | - Mark W Clemens
- Department of Plastic Surgery, MD Anderson Cancer Center, University of Texas, Houston, Texas, USA.
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Petrella F, Lo Iacono G, Casiraghi M, Gherzi L, Prisciandaro E, Garusi C, Spaggiari L. Chest wall resection and reconstruction by composite prosthesis for locally recurrent breast carcinoma. J Thorac Dis 2020; 12:39-41. [PMID: 32055423 DOI: 10.21037/jtd.2019.07.92] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Affiliation(s)
- Francesco Petrella
- Department of Thoracic Surgery, IRCCS European Institute of Oncology, Milan, Italy.,Department of Oncology and Hemato-oncology, University of Milan, Milan, Italy
| | - Giorgio Lo Iacono
- Department of Thoracic Surgery, IRCCS European Institute of Oncology, Milan, Italy
| | - Monica Casiraghi
- Department of Thoracic Surgery, IRCCS European Institute of Oncology, Milan, Italy
| | - Lorenzo Gherzi
- Department of Thoracic Surgery, IRCCS European Institute of Oncology, Milan, Italy
| | - Elena Prisciandaro
- Department of Thoracic Surgery, IRCCS European Institute of Oncology, Milan, Italy
| | - Cristina Garusi
- Department of Plastic and Reconstructive Surgery, IRCCS European Institute of Oncology, Milan, Italy
| | - Lorenzo Spaggiari
- Department of Thoracic Surgery, IRCCS European Institute of Oncology, Milan, Italy.,Department of Oncology and Hemato-oncology, University of Milan, Milan, Italy
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16
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Marulli G, De Iaco G, Ferrigno P, De Palma A, Quercia R, Brascia D, Schiavon M, Mammana M, Rea F. Sternochondral replacement: use of cadaveric allograft for the reconstruction of anterior chest wall. J Thorac Dis 2020; 12:3-9. [PMID: 32055417 DOI: 10.21037/jtd.2019.07.82] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Background Sternum may be involved by different diseases such as trauma, infection after cardiac surgery, tumors (primary and secondary) or chest wall deformities. Surgical excision with a safety margin is the primary goal after sternal resection for tumors, prevention of respiratory impairment due to flail chest and deformity and protection of surrounding organs are other important aims. Various techniques and materials have been used for this operation. We describe the use of cadaveric sternal allograft to reconstruct the chest wall in fourteen patients. Methods Between October 2008 and February 2017, five males and nine females underwent surgical procedure because of primary sternal neoplasm, single-site metastatic disease, neuroendocrine thymic carcinoma and sternal dehiscence after cardiac surgery. Results Fourteen sternectomy were undertaken. A muscle flap of pectoralis major was prepared to cover the graft in 9 patients. Adjuvant chemotherapy and radiotherapy were performed after surgery in three patients. No postoperative complications happened in 11 cases (84.6%). One (7.1%) patient died 9 days after surgery because of pulmonary embolism. Two patients (15.4%) had complications: one presented fever caused by systemic candidiasis and one had a muscle flap bleeding. Hospitalization median time was 11 days (range, 6-31 days). At follow up, 7 patients were alive in absence of disease, 1 patient is alive with recurrence, 6 patients died but nor infection neither rejection of the graft happened. No respiratory impairment or flail chest were registered in any patients. Conclusions This technique for sternal replacement in our experience can be considered safe with long term results, providing optimal chest wall stability. The allograft resulted well-tolerated permitting an optimal graft integration in the host.
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Affiliation(s)
| | - Giulia De Iaco
- Thoracic Surgery Unit, University Hospital of Bari, Bari, Italy
| | - Pia Ferrigno
- Thoracic Surgery Unit, University Hospital of Padova, Padova, Italy
| | - Angela De Palma
- Thoracic Surgery Unit, University Hospital of Bari, Bari, Italy
| | - Rosatea Quercia
- Thoracic Surgery Unit, University Hospital of Bari, Bari, Italy
| | - Debora Brascia
- Thoracic Surgery Unit, University Hospital of Bari, Bari, Italy
| | - Marco Schiavon
- Thoracic Surgery Unit, University Hospital of Padova, Padova, Italy
| | - Marco Mammana
- Thoracic Surgery Unit, University Hospital of Padova, Padova, Italy
| | - Federico Rea
- Thoracic Surgery Unit, University Hospital of Padova, Padova, Italy
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Ahmad SB, Hoellwarth J, Christie N, Mcgough R. Radical resection of a giant rib osteosarcoma with complex chest wall reconstruction. Int J Surg Case Rep 2019; 62:17-20. [PMID: 31415940 PMCID: PMC6702432 DOI: 10.1016/j.ijscr.2019.07.080] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2019] [Revised: 07/09/2019] [Accepted: 07/29/2019] [Indexed: 12/30/2022] Open
Abstract
A 61-year-old male with a 20 cm primary osteosarcoma of the rib underwent a radical en bloc chest wall resection. Chest wall reconstruction was performed using a poly methyl methacrylate (“bone cement”) and polypropylene mesh “sandwich”. Functional, cosmetic, and oncologic outcomes at 6 months are excellent. Polypropylene mesh and “bone cement” represent a safe, easy, and affordable approach to reconstructing the rib cage even in cases of large defects.
Introduction Primary rib osteosarcoma is a rare chest wall tumor with variable presentation. Large tumors greater than 10 cm are even rarer and present a challenge for surgical management. Presentation of case A 61-year-old male with a giant osteosarcoma of the left 2nd rib underwent multidisciplinary management including induction therapy with doxorubicin and cisplatin, followed by en bloc resection with left ribs 1–5, spinous processes of ribs 2–5, small volume lung resection, and chest wall reconstruction with polypropylene mesh and poly methyl methacrylate (PMMA or bone cement). There were no perioperative complications. At 6 months follow-up, the patient remains disease-free. Functional and cosmetic outcome are excellent. Discussion This 20 cm mass and resection of ribs 1–5 with resulting 25 cm chest wall defect is the largest primary rib osteosarcoma reported in literature. An R0 resection and chest wall reconstruction using polypropylene mesh and bone cement was feasible and safe. Conclusion Giant chest wall defects involving multi-rib resection can be effectively reconstructed with commonly available and inexpensive polypropylene mesh and PMMA to achieve good cosmetic and functional outcomes.
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Affiliation(s)
- Sarwat B Ahmad
- Division of Surgical Oncology, Department of Surgery, University of Pittsburgh School of Medicine, 5230 Centre Ave, Pittsburgh, PA 15232, USA.
| | - Jason Hoellwarth
- Department of Orthopedic Surgery, University of Pittsburgh School of Medicine, 5230 Centre Ave, Pittsburgh, PA 15232, USA
| | - Neil Christie
- Division of Thoracic Surgery, University of Pittsburgh School of Medicine, 5230 Centre Ave, Pittsburgh, PA 15232, USA
| | - Richard Mcgough
- Department of Orthopedic Surgery, University of Pittsburgh School of Medicine, 5230 Centre Ave, Pittsburgh, PA 15232, USA
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Wen X, Gao S, Feng J, Li S, Gao R, Zhang G. Chest-wall reconstruction with a customized titanium-alloy prosthesis fabricated by 3D printing and rapid prototyping. J Cardiothorac Surg 2018; 13:4. [PMID: 29310677 PMCID: PMC5759864 DOI: 10.1186/s13019-017-0692-3] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2017] [Accepted: 12/29/2017] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND As 3D printing technology emerge, there is increasing demand for a more customizable implant in the repair of chest-wall bony defects. This article aims to present a custom design and fabrication method for repairing bony defects of the chest wall following tumour resection, which utilizes three-dimensional (3D) printing and rapid-prototyping technology. METHODS A 3D model of the bony defect was generated after acquiring helical CT data. A customized prosthesis was then designed using computer-aided design (CAD) and mirroring technology, and fabricated using titanium-alloy powder. The mechanical properties of the printed prosthesis were investigated using ANSYS software. RESULTS The yield strength of the titanium-alloy prosthesis was 950 ± 14 MPa (mean ± SD), and its ultimate strength was 1005 ± 26 MPa. The 3D finite element analyses revealed that the equivalent stress distribution of each prosthesis was unifrom. The symmetry and reconstruction quality contour of the repaired chest wall was satisfactory. No rejection or infection occurred during the 6-month follow-up period. CONCLUSION Chest-wall reconstruction with a customized titanium-alloy prosthesis is a reliable technique for repairing bony defects.
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Affiliation(s)
- Xiaopeng Wen
- Department of Thoracic Surgery, First Affiliated Hospital of Xi'an Jiaotong University, #277 West Yanta Road, Xi'an, Shaanxi Province, 710061, People's Republic of China
| | - Shan Gao
- Department of Thoracic Surgery, First Affiliated Hospital of Xi'an Jiaotong University, #277 West Yanta Road, Xi'an, Shaanxi Province, 710061, People's Republic of China
| | - Jinteng Feng
- Department of Thoracic Surgery, First Affiliated Hospital of Xi'an Jiaotong University, #277 West Yanta Road, Xi'an, Shaanxi Province, 710061, People's Republic of China
| | - Shuo Li
- Department of Thoracic Surgery, First Affiliated Hospital of Xi'an Jiaotong University, #277 West Yanta Road, Xi'an, Shaanxi Province, 710061, People's Republic of China
| | - Rui Gao
- Department of Thoracic Surgery, First Affiliated Hospital of Xi'an Jiaotong University, #277 West Yanta Road, Xi'an, Shaanxi Province, 710061, People's Republic of China
| | - Guangjian Zhang
- Department of Thoracic Surgery, First Affiliated Hospital of Xi'an Jiaotong University, #277 West Yanta Road, Xi'an, Shaanxi Province, 710061, People's Republic of China.
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Betancourt Cuellar SL, Heller L, Palacio DP, Hofstetter WL, Marom EM. Intra- and Extra-Thoracic Muscle Flaps and Chest Wall Reconstruction Following Resection of Thoracic Tumors. Semin Ultrasound CT MR 2017; 38:604-615. [PMID: 29179900 DOI: 10.1053/j.sult.2017.07.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Improvements in surgical technique over the last decade enable surgeons to perform extensive resection and reconstruction in patients presenting with tumors involving the soft tissue or bony structures of the chest wall. The type of surgical resection and its size, depend on the type of tumor resected and its location. In addition to providing a better esthetic result, the reconstruction restores support and functionality of the thoracic cage. The approach to chest wall repair includes primary closure or reconstruction by using transposition flaps, free flaps, prosthetic material, or a mixture of a flap and prosthetic material.
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Affiliation(s)
- Sonia L Betancourt Cuellar
- Department of Diagnostic Radiology, The University of Texas, MD Anderson Cancer Center, Houston, TX; Address reprint requests to Sonia L. Betancourt Cuellar, MD, Diagnostic Radiology Department, The University of Texas, MD Anderson Cancer Center, 1515 Holcombe Blvd, Houston, TX 77030.
| | - Lior Heller
- Department of Plastic Surgery, Assaf Harofeh Medical Center, Zerifin, Israel
| | - Diana P Palacio
- Department of Diagnostic Radiology, University of Arizona, Medical Center, Tucson, AZ
| | - Wayne L Hofstetter
- Department of Thoracic and Cardiovascular Surgery, The University of Texas, MD Anderson Cancer Center, Houston, TX
| | - Edith M Marom
- Department of Diagnostic Radiology, The University of Texas, MD Anderson Cancer Center, Houston, TX; Department of Diagnostic Imaging, The Chaim Sheba Medical Center, Ramat-Gan, Israel, affiliated with the Tel Aviv University, Israel
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Hussain ON, Sabbagh MD, Carlsen BT. Complex Microsurgical Reconstruction After Tumor Resection in the Trunk and Extremities. Clin Plast Surg 2017; 44:299-311. [PMID: 28340664 DOI: 10.1016/j.cps.2016.11.008] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Reconstruction of soft tissue defects following tumor ablation procedures in the trunk and extremities can challenge the microsurgeon. The goal is not just to provide adequate soft tissue coverage but also to restore form and function and minimize donor site morbidity. Although the principles of the reconstructive ladder still apply in the trunk and extremities, free tissue transfer is used in many cases to optimally restore form and function. Microsurgery has changed the practice in soft tissue tumors, and amputation is less frequently necessary.
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Affiliation(s)
- Omar N Hussain
- Division of Plastic and Reconstructive Surgery, Mayo Clinic, 200 First Street, Rochester, MN 55905, USA
| | - M Diya Sabbagh
- Division of Plastic and Reconstructive Surgery, Mayo Clinic, 200 First Street, Rochester, MN 55905, USA
| | - Brian T Carlsen
- Division of Plastic and Reconstructive Surgery, Mayo Clinic, 200 First Street, Rochester, MN 55905, USA.
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Marulli G, Dell'amore A, Calabrese F, Schiavon M, Daddi N, Dolci G, Stella F, Rea F. Safety and Effectiveness of Cadaveric Allograft Sternochondral Replacement After Sternectomy: A New Tool for the Reconstruction of Anterior Chest Wall. Ann Thorac Surg 2016; 103:898-905. [PMID: 27825689 DOI: 10.1016/j.athoracsur.2016.08.093] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/22/2016] [Revised: 08/23/2016] [Accepted: 08/23/2016] [Indexed: 11/28/2022]
Abstract
BACKGROUND Surgical excision with wide margins, prevention of respiratory impairment, and protection of surrounding organs are primary goals in resection and reconstruction of the chest wall. We describe our experience of the use of cadaveric cryopreserved sternal allograft. METHODS Eighteen patients underwent surgery. Indications for sternectomy were sternal metastases (n = 9), primary chondrosarcoma (n = 4), sternal dehiscence (n = 2), soft tissue sarcoma (n = 1), malignant solitary fibrous tumor (n = 1), and direct involvement of thymic carcinoma (n = 1). The defect was reconstructed using a cadaveric sternal allograft harvested aseptically, treated with antibiotic solution, and cryopreserved (-80°C). The graft was tailored to fit the defect and fixed in place with titanium plates and screws. RESULTS Four patients underwent a total sternectomy, 8 a partial lower sternectomy, and 6 a partial upper sternectomy. In 14 patients, muscle flaps were positioned to cover the graft. During the postoperative course, 1 patient died of pulmonary embolism, 1 had systemic Candida infection, and 1 had surgical revision for bleeding at the site of muscle flap. One patient required removal of a screw on the clavicle 4 months after operation because of partial dislocation. At a median follow-up of 36 months, neither infection nor rejection of the graft occurred; 13 patients are alive without disease, and 4 patients had died. None had local tumor relapse. CONCLUSIONS Sternal replacement with cadaveric allograft is safe and effective, providing optimal stability of the chest wall and protection of the surrounding organs, even after extensive chest wall resections. The allograft was biologically well tolerated, allowing a perfect integration into the host.
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Affiliation(s)
- Giuseppe Marulli
- Thoracic Surgery Unit, Department of Cardiologic, Thoracic, and Vascular Sciences, University Hospital of Padua, Padua, Italy.
| | - Andrea Dell'amore
- Thoracic Surgery Unit, S. Orsola-Malpighi University Hospital, Bologna, Italy
| | - Francesca Calabrese
- Thoracic Surgery Unit, Department of Cardiologic, Thoracic, and Vascular Sciences, University Hospital of Padua, Padua, Italy
| | - Marco Schiavon
- Thoracic Surgery Unit, Department of Cardiologic, Thoracic, and Vascular Sciences, University Hospital of Padua, Padua, Italy
| | - Niccolò Daddi
- Thoracic Surgery Unit, S. Orsola-Malpighi University Hospital, Bologna, Italy
| | - Giampiero Dolci
- Thoracic Surgery Unit, S. Orsola-Malpighi University Hospital, Bologna, Italy
| | - Franco Stella
- Thoracic Surgery Unit, S. Orsola-Malpighi University Hospital, Bologna, Italy
| | - Federico Rea
- Thoracic Surgery Unit, Department of Cardiologic, Thoracic, and Vascular Sciences, University Hospital of Padua, Padua, Italy
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Zhang R, Mägel L, Jonigk D, Länger F, Lippmann T, Zardo P, Pölzing F. Biosynthetic Nanostructured Cellulose Patch for Chest Wall Reconstruction: Five-Month Follow-up in a Porcine Model. J INVEST SURG 2016; 30:297-302. [PMID: 27768401 DOI: 10.1080/08941939.2016.1244310] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
PURPOSE Ideal approaches and materials for reconstruction of large chest wall defects remain a topic of debate. We sought to explore the suitability of a reinforced nanostructured cellulose (NC) patch for chest wall reconstruction in an animal model. MATERIALS AND METHODS In four domestic pigs, a standardized 10 × 10 cm chest wall defect was created by resecting three rib segments. Subsequently the defect was reconstructed via a biosynthetic NC patch (16 × 12 cm) reinforced by polytetrafluoroethylene mesh. After 1, 2, 4, and 5 months respectively, gross examination of NC patches was performed following sacrifice of the animals. Specimens of NC patches and surrounding connective tissue underwent histological examinations after staining with Hematoxylin-eosin and Elastica van Gieson. RESULTS All animals survived their observation period without encountering major adverse events. On gross examination all NC patches were intact and well integrated into the surrounding tissue. Histological examination showed clearly demarked zones of foreign body reaction at the patch/host-tissue interface. After 5 months a slight increase in foreign body reaction, fibrous capsule formation and cellular infiltration were observed. No signs of fibroblast proliferation or neovascularization were seen within NC patches at any point. CONCLUSIONS Our findings suggest a quick healing process and good overall biocompatibility following NC patch implantation.NC might prove an efficient and suitable biomaterial for complex chest wall reconstruction.
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Affiliation(s)
- Ruoyu Zhang
- a Department of Thoracic Surgery , Center for Pneumology and Thoracic Surgery, Schillerhoehe Hospital, Teaching Hospital of the University of Tuebingen , Gerlingen , Germany
| | - Lavinia Mägel
- b Institute of Pathology, Hannover Medical School , Hannover , Germany
| | - Danny Jonigk
- b Institute of Pathology, Hannover Medical School , Hannover , Germany
| | - Florian Länger
- b Institute of Pathology, Hannover Medical School , Hannover , Germany
| | - Torsten Lippmann
- b Institute of Pathology, Hannover Medical School , Hannover , Germany
| | - Patrick Zardo
- c Department of Cardiac and Thoracic Surgery , Otto-von-Guericke University Magdeburg , Magdeburg , Germany
| | - Frank Pölzing
- d Fördergemeinschaft für innovative Medizin , Beichlingen , Germany
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Zhang Y, Li JZ, Hao YJ, Lu XC, Shi HL, Liu Y, Zhang PF. Sternal tumor resection and reconstruction with titanium mesh: a preliminary study. Orthop Surg 2016; 7:155-60. [PMID: 26033997 DOI: 10.1111/os.12169] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/12/2014] [Accepted: 03/16/2015] [Indexed: 01/08/2023] Open
Abstract
OBJECTIVE To explore the clinical efficacy and complications of treating sternal tumors by resection and titanium mesh thoracic reconstruction. METHODS This retrospective analysis of eight patients with sternal tumors treated in the Department of Orthopedic Surgery at the First Affiliated Hospital of Zhengzhou University from January 2008 to June 2012 included five men and three women aged 37-66 years (mean, 50.4 years). The histological diagnoses were chondrosarcoma (two cases), osteosarcoma (one), malignant fibrous histiocytoma (two), eosinophilic granuloma (one) and sternal metastasis from breast cancer (two). The tumors were invading the manubrium sterni (three cases), manubrium sterni and body (three) and sternal body (two). All patients underwent needle or incisional biopsy prior to sternal tumor resection and titanium mesh thoracic reconstruction. RESULTS All patients were followed for 9 months to 4 years. There were no intraoperative complications or operative or postoperative deaths. One patient developed a deep wound hematoma 1 week postoperatively; incisional drainage and debridement resulting in healing within 2 weeks. There was no loosening or exsertion of the titanium mesh and no patients developed respiratory complications or thoracic deformity. One patient with malignant fibrous histiocytoma died of lung metastases 9 months postoperatively, another with malignant fibrous histiocytoma died of liver metastases 14 months postoperatively; the remaining patients survived without tumor recurrence. CONCLUSION Titanium mesh chest reconstruction after sternal tumor resection has the advantages of simplifying the procedure, achieving a good shape and having few complications. Titanium mesh is an ideal material for reconstruction of the sternum.
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Affiliation(s)
- Yan Zhang
- Department of Orthopaedics, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Jia-zhen Li
- Department of Orthopaedics, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Ying-jie Hao
- Department of Orthopaedics, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Xin-chang Lu
- Department of Orthopaedics, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Hai-long Shi
- Department of Orthopaedics, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Yuan Liu
- Department of Orthopaedics, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Peng-fei Zhang
- Department of Orthopaedics, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
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Chest Wall Reconstruction: Evolution Over a Decade and Experience With a Novel Technique for Complex Defects. Ann Plast Surg 2015; 76:231-7. [PMID: 25992971 DOI: 10.1097/sap.0000000000000502] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Chest wall reconstruction (CWR) with biologic matrices has gained popularity over the last decade; however, data on this topic remain sparse. The aim of this study is to review the different methods and materials used for CWR while reviewing and highlighting a novel approach using a biologic inlay and synthetic onlay technique for larger, complex high-risk defects. METHODS A retrospective review was performed of all patients who underwent full thickness chest wall resection and reconstruction during a 10-year period. Patient characteristics, comorbidities, operative data, as well as postoperative wound complications and outcomes were reviewed. Different reconstructive methods and materials were reviewed and compared. RESULTS From December 2003 to January 2014, a total of 81 patients underwent CWR. The indications for resection/reconstruction included oncologic in 49 patients (60.5%), desmoids tumors in 10 (12.3%), bronchopleural fistula in 3 (3.7%), infection in 7 (8.6%), and anatomic deformity in 7 (8.6%) patients. Synthetic and/or acellular dermal matrices (ADM) reconstruction was used in 59 patients (10 biologic, 22 synthetic, and 27 biologic ADM inlay/synthetic onlay combination). On average, 2.5, 3.5, and 3.6 ribs were resected in the biologic, synthetic, and combination group, respectively (P = 0.1). A greater number of patients in the combination group had a history of chemotherapy and/or radiation therapy (P = 0.03) than the synthetic or biologic alone groups. Risk analysis demonstrated an association between the number of ribs resected and postoperative chest wall complications. The incidence of chest wall/wound complications in the synthetic, combination, and biologic groups was 31.8%, 22.2%, and 10%, respectively (P = 0.47). CONCLUSIONS In the largest single institution study comparing the use of different reconstructive materials, including ADM in CWR, the authors demonstrate that a biologic inlay/synthetic onlay may be used effectively for high-risk, large complex defects. Early outcomes with this technique are promising. The authors believe this combination highlights benefits from both materials because the ADM facilitates tissue ingrowth and revascularization, whereas the synthetic component provides structural durability. Additional studies with larger sample sizes are necessary to further explore the benefits of the combination technique to determine if outcomes are better than either material alone when used to reconstruct high-risk wounds after larger resections.
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Abstract
Most chest wall defects requiring reconstruction result from tumor resection. Bone and soft tissue sarcomas and recurrent mammary cancer are the most common tumors. Careful preoperative evaluation, meticulous surgical technique and active postoperative treatment are important. The selection of reconstruction is based on the nature, size and location of the defect as well as on the general health and prognosis of the patient. The goals of the reconstruction are adequate stability, water- and airtight closure of the chest cavity, and acceptable cosmetic appearance. The pedicled muscular or musculocutaneous flaps are usually the first choice for tis-sue coverage. These include flaps such as latissimus dorsi, vertical or transverse rectus abdominis and pectoralis. In certain cases also the breast flap or omental flap can be used. In selected cases, a free flap reconstruction is indicated if the local options for reconstruction have been used, or if they are unreliable due to earlier scars or radiotherapy. The free flaps to be used for chest wall can be harvested from the thigh (tensor fascia latae flap, anterolateral thigh flap), from the abdomen (transverse rectus abdominis flaps, deep epigastric perforator flaps) or from the chest wall (latissimus dorsi flap and other flaps based on the subscapular artery). Sometimes a fillet forearm can be used as a flap to cover a defect after extended forequarter amputation. Artificial meshes are commonly used to give stability in the defect and to give a platform for the flap. Methylmethacrylate embedded between the two layers of a mesh, or one or two rib grafts fixed to the mesh, can be used to give additional stability in extensive defects to prevent paradoxical movement.
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Affiliation(s)
- E Tukiainen
- Department of Plastic Surgery, Helsinki University Hospital, Helsinki, Finland.
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Celik S, Aydemir C, Gürer O, Işık O. Symptomatic intercostal lung hernia secondary to sternal dehiscence surgery. AMERICAN JOURNAL OF CASE REPORTS 2013; 14:198-200. [PMID: 23826467 PMCID: PMC3700496 DOI: 10.12659/ajcr.883950] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2012] [Accepted: 02/08/2013] [Indexed: 11/09/2022]
Abstract
Patient: Male, 60 Final Diagnosis: Iatrogenic intercostal lung hernia Symptoms: — Medication: No medication Clinical Procedure: Surgically cerrected Specialty: Thoracic surgery
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Affiliation(s)
- Sezai Celik
- Department of Thoracic Surgery, Medicana Hospitals Çamlıca, Istanbul, Turkey
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Mahabir RC, Butler CE. Stabilization of the chest wall: autologous and alloplastic reconstructions. Semin Plast Surg 2012; 25:34-42. [PMID: 22294941 DOI: 10.1055/s-0031-1275169] [Citation(s) in RCA: 49] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
Abstract
The goals of chest wall stabilization include maintenance of a rigid airtight cavity, protection of the thoracic and abdominal contents, optimization of respiration, and, whenever possible, an aesthetic reconstruction. Evidence suggests that bony fixation results in reduced ventilator dependence, a shorter overall hospital stay, and improved upper extremity function. We prefer to accomplish this with autologous tissue alone (such as the pectoralis major, latissimus dorsi, or rectus abdominus muscle flaps) for small to moderate defects. En bloc resection of defects larger than 5 cm or containing four or more ribs will likely benefit from chest wall stabilization. For patients previously treated with radiation, even larger defects may be tolerated owing to fibrosis. For these larger defects, methyl methacrylate composite meshes are used and covered with vascularized tissue. Contaminated wounds are generally reconstructed with bioprosthetic mesh rather than synthetic mesh. Using these principles, the reconstructive plastic surgeon can devise a comprehensive and safe plan to repair tremendous defects of the chest wall.
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Clemens MW, Evans KK, Mardini S, Arnold PG. Introduction to chest wall reconstruction: anatomy and physiology of the chest and indications for chest wall reconstruction. Semin Plast Surg 2012; 25:5-15. [PMID: 22294938 DOI: 10.1055/s-0031-1275166] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
The chest wall functions as a protective cage around the vital organs of the body, and significant disruption of its structure can have dire respiratory and circulatory consequences. The past several decades have seen a marked improvement in the management and reconstruction of complex chest wall defects. Widespread acceptance of muscle and musculocutaneous flaps such as the latissimus dorsi, pectoralis major, serratus anterior, and rectus abdominis has led to a sharp decrease in infections and mortality. Successful reconstructions are dependent upon a detailed knowledge of the functional anatomy and blood supply of the chest and the underlying pathophysiology of a particular disease process. This article will provide an overview of key principles and evidence-based approaches to chest wall reconstruction.
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Haddock NT, Weichman KE, Saadeh PB. Reconstruction of a massive thoracic defect: The use of anatomic rib-spanning plates. J Plast Reconstr Aesthet Surg 2012; 65:e253-6. [DOI: 10.1016/j.bjps.2012.04.042] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2012] [Revised: 04/12/2012] [Accepted: 04/26/2012] [Indexed: 10/28/2022]
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The combination of polytetrafluoroethylene mesh and titanium rib implants: an innovative process for reconstructing large full thickness chest wall defects. Eur J Cardiothorac Surg 2012; 42:444-53. [DOI: 10.1093/ejcts/ezs028] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
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Roje Z, Roje Ž, Matić D, Librenjak D, Dokuzović S, Varvodić J. Necrotizing fasciitis: literature review of contemporary strategies for diagnosing and management with three case reports: torso, abdominal wall, upper and lower limbs. World J Emerg Surg 2011; 6:46. [PMID: 22196774 PMCID: PMC3310784 DOI: 10.1186/1749-7922-6-46] [Citation(s) in RCA: 86] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2011] [Accepted: 12/23/2011] [Indexed: 12/20/2022] Open
Abstract
Necrotizing fasciitis (NF) is an uncommon soft tissue infection, usually caused by toxin-producing virulent bacteria. It is characterized by widespread fascial necrosis primarily caused by Streptococcus hemolyticus. Shortly after the onset of the disease, patients become colonized with their own aerobic and anaerobic microflora from the gastrointestinal and/or urogenital tracts. Early diagnosis with aggressive multidisciplinary treatment is mandatory. We describe three clinical cases with NF. The first is a 69 years old man with diabetes mellitus type II, who presented with NF on the posterior chest wall, shoulder and arm. He was admitted to the intensive care unit (ICU) with a clinical picture of severe sepsis. Outpatient treatment and early surgical debridement of the affected zones (inside 3 hours after admittance) and critical care therapy were performed. The second case is of a 63 years old paraplegic man with diabetes mellitus type I. Pressure sores and perineal abscesses progressed to Fournier's gangrene of the perineum and scrotum. He had NF of the anterior abdominal wall and the right thigh. Outpatient treatment and early surgical debridement of the affected zones (inside 6 hour after admittance) and critical care therapy were performed. The third patient was a 56 year old man who had NF of the anterior abdominal wall, flank and retroperitoneal space. He had an operation of the direct inguinal hernia, which was complicated with a bowel perforation and secondary peritonitis. After establishing the diagnosis of NF of the abdominal wall and retroperitoneal space (RS), he was transferred to the ICU. There he first received intensive care therapy, after which emergency surgical debridement of the abdominal wall, left colectomy, and extensive debridement of the RS were done (72 hours after operation of inquinal hernia). On average, 4 serial debridements were performed in each patient. The median of serial debridement in all three cases was four times. Other intensive care therapy with a combination of antibiotics and adjuvant hyperbaric oxygen therapy (HBOT) was applied during the treatment. After stabilization of soft tissue wounds and the formation of fresh granulation tissue, soft tissue defect were reconstructed using simple to complex reconstructive methods.
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Affiliation(s)
- Zdravko Roje
- Division of Plastic Surgery and Burns, University Hospital Centre Split, Croatia
| | - Željka Roje
- Department of Surgery, University Hospital Dubrava, Zagreb, Croatia
| | - Dario Matić
- Department of Surgery, University Hospital Centre Split, Croatia
| | - Davor Librenjak
- Department of Urology, University Hospital Centre Split, Croatia
| | - Stjepan Dokuzović
- Department of Orthopedic Surgery, University Hospital Dubrava, Zagreb, Croatia
| | - Josip Varvodić
- Deparment of Neurosurgery, University Hospital Dubrava, Zagreb, Croatia
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Berthet JP, Canaud L, D'Annoville T, Alric P, Marty-Ane CH. Titanium Plates and Dualmesh: A Modern Combination for Reconstructing Very Large Chest Wall Defects. Ann Thorac Surg 2011; 91:1709-16. [DOI: 10.1016/j.athoracsur.2011.02.014] [Citation(s) in RCA: 53] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/10/2010] [Revised: 01/31/2011] [Accepted: 02/04/2011] [Indexed: 11/15/2022]
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D'Alessandro P, Carey-Smith R, Wood D. Large resection and reconstruction of primary parietal thoracic sarcoma: a multidisciplinary approach on 11 patients at minimum 2-years follow-up. Orthop Traumatol Surg Res 2011; 97:73-8. [PMID: 21159567 DOI: 10.1016/j.otsr.2010.09.014] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/09/2010] [Revised: 07/13/2010] [Accepted: 09/06/2010] [Indexed: 02/02/2023]
Abstract
BACKGROUND Thoracic sarcomas are rare, and resection can leave behind defects that require significant reconstruction by the multidisciplinary surgical team. The aim of this study is to review the experience of our regional referral centre with primary thoracic tumor resection and thoracic reconstruction. METHODS We have reviewed the treatment of all chest wall tumors resected at Sir Charles Gairdner Hospital in Western Australia over a 5-year period. There were 11 cases in total that involved removal of deep muscle, ribs and/or sternum. RESULTS In the six cases that required bony resection, the surgical team utilized a Gore-Tex (e-PTFE) mesh prosthesis to allow immediate closure of the defect, whilst five other closures were achievable using primary layered closure alone. Four patients had postoperative complications, including one who required prosthesis removal. Mean length of hospital stay was 5 days. No 30-day or 6-month mortality was recorded. All patients were followed-up for a minimum of 24 months, and all patients were alive and free of disease at their most recent follow-up. CONCLUSIONS This study concurs with previous literature indicating that thoracic tumor resection and immediate reconstruction often involving use of prosthetic mesh is a safe and effective one stage surgical procedure for a variety of chest wall defects with low postoperative morbidity.
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Affiliation(s)
- P D'Alessandro
- Orthopaedic Department, Sir Charles Gairdner Hospital, Perth, Western Australia.
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36
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Chang SH, Tung KY, Hsiao HT, Chen CH, Liu HK. Combined free vascularized iliac osteocutaneous flap and pedicled pectoralis major myocutaneous flap for reconstruction of anterior chest wall full-thickness defect. Ann Thorac Surg 2011; 91:586-8. [PMID: 21256320 DOI: 10.1016/j.athoracsur.2010.07.042] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/10/2010] [Revised: 07/01/2010] [Accepted: 07/14/2010] [Indexed: 10/18/2022]
Abstract
Large defects of the anterior chest wall lead to gross chest instability that can result in paradoxic respiration. Osteoradionecrosis of the lower sternum and multiple left ribs resulted in a huge, full-thickness defect of the left anterior chest wall in a 67-year-old woman. An iliac osteocutaneous flap (bone segment 3 × 14 cm) was harvested for reconstruction of the bone defect. The skin defect was covered by the skin paddle of the iliac osteocutaneous flap and a contralateral rotational pectoralis major muscle flap. Months postoperatively, the patient was physically active, the chest was stable, and the vascularized iliac bone was incorporated into the recipient bone.
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Affiliation(s)
- Shih-Hsin Chang
- Department of Plastic Surgery, Mackay Memorial Hospital, Taipei, Taiwan, Republic of China.
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38
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D’Aiuto M, Cicalese M, D’Aiuto G, Rocco G. Surgery of the Chest Wall for Involvement by Breast Cancer. Thorac Surg Clin 2010; 20:509-17. [DOI: 10.1016/j.thorsurg.2010.09.001] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Langer V. Reconstruction in Warfare Injuries. Med J Armed Forces India 2010; 66:350-3. [PMID: 27365741 PMCID: PMC4919818 DOI: 10.1016/s0377-1237(10)80016-4] [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: 10/18/2022] Open
Abstract
Traumatic injuries, especially in the combat setting, stress the surgical team that may be sited in a remote forward area, battling against paucity of time, resources and infrastructure. The lone surgeon may be faced with the arduous challenge of saving life. There is seldom thought given to reconstruction in this high-pressure situation. If the patient survives, morbidity for want of reconstruction can be severe and quality of life can suffer significantly. Reconstruction after 3 to 5 days is fraught with complications and usually does compromise outcome in the post-operative phase. The reconstructive surgeon should be involved early in the management as he can provide coverage for large soft tissue defects after aggressive debridement with panache. If the patient is haemodynamically stable, he should be transferred urgently, preferrably by air, to a higher centre with multi-specialty care, especially being equipped with an orthopaedic and trauma reconstructive surgeon. It has been proved beyond doubt that the healing improves significantly and there is marked decrease in morbidity if coverage of wounds is provided early, before colonized wounds get infected.
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Affiliation(s)
- V Langer
- Reader, Department of Surgery, Armed Forces Medical College, Pune-40
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40
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Chest Wall Reconstruction with Creation of Neoribs Using Mesenchymal Cell Bone Allograft and Porcine Small Intestinal Submucosa. Plast Reconstr Surg 2010; 126:148e-149e. [DOI: 10.1097/prs.0b013e3181e3b5ad] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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41
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Lasso JM, Uceda M, Peñalver R, Moreno N, Casteleiro R, Cano RP. Large posterior chest wall defect reconstructed with a de-epithelised trans-thoracic TRAM flap. J Plast Reconstr Aesthet Surg 2010; 63:e458-62. [PMID: 19699698 DOI: 10.1016/j.bjps.2009.07.003] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2009] [Revised: 06/25/2009] [Accepted: 07/01/2009] [Indexed: 10/20/2022]
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42
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Marulli G, Hamad AM, Schiavon M, Azzena B, Mazzoleni F, Rea F. Geometric reconstruction of the right hemi-trunk after resection of giant chondrosarcoma. Ann Thorac Surg 2010; 89:306-8. [PMID: 20103269 DOI: 10.1016/j.athoracsur.2009.06.075] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/30/2009] [Revised: 05/29/2009] [Accepted: 06/09/2009] [Indexed: 11/28/2022]
Abstract
We present a case of a giant chondrosarcoma arising from the right anterolateral chest wall and extending to the abdomen. An extensive resection of the right lower chest wall, most of the right hemidiaphragm, and most of the anterior abdominal wall on the right side was carried out. A long titanium plate was used to reconstruct the right costal margin. This plate gave attachment to two polytetrafluoroethylene meshes that were used to cover the abdominal and chest wall defects. The patches were covered with pedicled muscles and omental flaps and subsequently with rotational skin flap.
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Affiliation(s)
- Giuseppe Marulli
- Division of Thoracic Surgery, University of Padova, Padova, Italy
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43
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Trunk Reconstruction. Plast Reconstr Surg 2010. [DOI: 10.1007/978-1-84882-513-0_44] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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44
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Zhu H, Zhou K, Zhang L, Jin C, Peng S, Yang W, Li K, Su H, Chen W, Bai J, Wu F, Wang Z. High intensity focused ultrasound (HIFU) therapy for local treatment of hepatocellular carcinoma: Role of partial rib resection. Eur J Radiol 2009; 72:160-6. [DOI: 10.1016/j.ejrad.2008.07.003] [Citation(s) in RCA: 49] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2008] [Revised: 05/17/2008] [Accepted: 07/03/2008] [Indexed: 10/21/2022]
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45
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Galbis Caravajal JM, Yeste Sánchez L, Fuster Diana CA, Guijarro Jorge R, Fernández Ortiz P, Deaville PJ. Sternal resection and reconstruction after malignant tumours. Clin Transl Oncol 2009; 11:91-5. [PMID: 19211374 DOI: 10.1007/s12094-009-0320-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
AIM We present our experience of the resection of sternal tumours (both primary and metastatic), followed by reconstruction of soft-tissue and skeletal defects with a mesh and musculocutaneous flap. METHODS Eleven patients were included in this study, all of which underwent sternal tumour resection and immediate chest wall repair. Reconstruction was accomplished with prosthetic material (polytetrafluoroethylene [PTFE]), a sandwich of polypropylene (Marlex-methylmethacrylate or titanium/polypropylene) and a pedicled musculocutaneous flap (pectoralis major, latissimus dorsi or rectus abdominis). Sternal tumours may arise from both primary (chondrosarcoma and neurofibrosarcoma) and secondary (local recurrence of breast carcinoma and metastatic disease from other organs) disease. RESULTS Extubation did not result in paradoxical respiration in any of the patients in the study. The post-operative mortality rate was seen to be zero. One patient with a PTFE prosthesis had chest failure requiring immediate intubation and posterior prosthesis replacement. One mesh was removed two months after surgery. There was local recurrence in one patient and five patients died from distal metastases. The final patient is still alive with metastases at the time of presenting our results. CONCLUSIONS Wide resection of sternal tumours provides good local control. Reconstruction with mesh and musculocutaneous flap is an effective technique for repairing such defects.
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Affiliation(s)
- J M Galbis Caravajal
- Department of Thoracic Surgery, General Universitary Hospital of Valencia, Valencia, Spain.
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46
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Santini M, Fiorello A, Vicidomini G, Busiello L. Pulmonary hernia secondary to limited access for mitral valve surgery and repaired by video thoracoscopic surgery. Interact Cardiovasc Thorac Surg 2009; 8:111-3. [DOI: 10.1510/icvts.2008.190744] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
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47
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Choisy-Klifa M, Binder JP, Revol M, Servant JM. Reconstruction des pariétectomies thoraciques effectuées pour récidive de cancer du sein. ANN CHIR PLAST ESTH 2008; 53:239-45. [PMID: 17590494 DOI: 10.1016/j.anplas.2007.05.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2006] [Accepted: 05/11/2007] [Indexed: 10/23/2022]
Abstract
Some recurrences of breast cancer require wide chest wall resection as curative or palliative therapy. We report a retrospective review of 14 chest wall resections and reconstructions. The width of the anterior chest wall excision was 150 cm(2) (80 to 360 cm(2)). Two defects were full-thickness ones, with sternal or costal resection. The reconstruction required synthetic mesh covered by a latissimus dorsi musculocutaneous flap. The 12 other resections were superficial ones, and have been covered by a skin graft in 5 patients, and by a regional flap in 7 patients (5 latissimus dorsi, 1 DIEP, and 1 bilobed flap). Two patients had a chest wall irradiation after the surgical procedure. We have analysed the factors, which had influenced our choice of the type of reconstruction. The reconstruction is performed by a regional flap, most commonly a latissimus dorsi pedicled flap, in case of full-thickness defect, of nodular isolated recurrence, or when a radiation therapy is provided after the surgical procedure. The coverage is made by a skin graft in case of palliative excision, or of multiple nodular chest wall recurrence (which have a high risk of recurrence in the same form).
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Affiliation(s)
- M Choisy-Klifa
- Service de chirurgie plastique, hôpital Saint-Louis, 1, avenue Claude-Vellefaux, 75475 Paris cedex 10, France.
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48
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Plastic Surgery. Surgery 2008. [DOI: 10.1007/978-0-387-68113-9_109] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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49
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Akhavani MA, Gore S, Kang N. Chest wall reconstruction using a prolene/hydroxyapatite paste sandwich. Plast Reconstr Surg 2007; 119:761-2. [PMID: 17230134 DOI: 10.1097/01.prs.0000254925.42803.32] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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50
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Rathinam S, Rajesh PB, Collins FJ. Chest wall and sternal resection and reconstruction. Multimed Man Cardiothorac Surg 2007; 2007:mmcts.2005.001784. [PMID: 24414019 DOI: 10.1510/mmcts.2005.001784] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
Chest wall resection is performed for a variety of conditions and has been a complex problem in the past due to intraoperative technical difficulties, surgical complications, and respiratory failure. Advances in the fields of surgery and anaesthesia and the team effort of the involved thoracic and plastic surgeons result in more aggressive resections with good results. The surgical technique of sternal excision and reconstruction with a Marlex methacrylate composite prosthesis as a part of chest wall resection and reconstruction series is described here in this chapter.
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Affiliation(s)
- Sridhar Rathinam
- Regional Department of Thoracic Surgery, Birmingham Heartlands Hospital, Bordesley Green East, Birmingham BS9 5SS, UK
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