1
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Girotti PNC, Bianchi F. Chest wall reconstruction, prosthesis and allografts: a narrative review. J Thorac Dis 2023; 15:7077-7087. [PMID: 38249910 PMCID: PMC10797370 DOI: 10.21037/jtd-23-650] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2023] [Accepted: 11/15/2023] [Indexed: 01/23/2024]
Abstract
Background and Objective What is the best material in the case of prosthesis used to replace major chest wall resection is still unknown. We reviewed most significant literature focused on the type of prosthetic materials available by highlighting their relative pros and cons. Methods We reviewed most significant articles, including clinical results of relevant case series (retrospective studies), published in English in the last 23 years: PubMed, Embase and Scopus databases were used in our search in the period between the 1st January 1999 and 31st December 2022. Key Content and Findings Overall, our literature review revealed lack of uniformity or conformity in the surgical strategies described for chest wall reconstruction with no internationally accepted standard in terms of decisions and optimal prosthetic materials and type of prostheses (soft, rigid, biological). Despite the increased interest in chest wall reconstruction, we observed a general lack of substantial prospective and multicentric studies. Likewise, there are not substantial data which may guide to the choice of optimal prosthetics in terms of characteristics and biocompatibility. Conclusions A variety of materials are available for reconstruction, including synthetic and biological meshes, flexible and rigid patches, and metal osteosynthesis systems. The material chosen should be optimized to each patient and damaged tissues to be restored. Prospective and multicentric studies are necessary to address current limits in this surgical field.
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Affiliation(s)
| | - Fabrizio Bianchi
- Unit of Cancer Biomarkers, Fondazione IRCCS Casa Sollievo della Sofferenza, San Giovanni Rotondo (FG), Italy
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2
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Lonnee PW, Ovadja ZN, Hulsker CCC, van de Sande MAJ, van de Ven CP, Paes EC. Reconstructive Strategies in Pediatric Patients after Oncological Chest Wall Resection: A Systematic Review. Eur J Pediatr Surg 2023; 33:431-440. [PMID: 36640758 DOI: 10.1055/a-2013-3074] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Abstract
An appropriate reconstruction strategy after surgical resection of chest wall tumors in children is important to optimize outcomes, but there is no consensus on the ideal approach. The aim of this study was to provide an up-to-date systematic review of the literature for different reconstruction strategies for chest wall defects in patients less than 18 years old. A systematic literature search of the complete available literature was performed and results were analyzed. A total of 22 articles were included in the analysis, which described a total of 130 chest wall reconstructions. All were retrospective analyses, including eight case reports. Reconstructive options were divided into primary closure (n = 21 [16.2%]), use of nonautologous materials (n = 83 [63.8%]), autologous tissue repair (n = 2 [1.5%]), or a combination of the latter two (n = 24 [18.5%]). Quality of evidence was poor, and the results mostly heterogeneous. Reconstruction of chest wall defects can be divided into four major categories, with each category including its own advantages and disadvantages. There is a need for higher quality evidence and guidelines, to be able to report uniformly on treatment outcomes and assess the appropriate reconstruction strategy.
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Affiliation(s)
- Pieter W Lonnee
- Department of Plastic, Reconstructive, and Hand Surgery, University Medical Center Utrecht, Wilhelmina Children's Hospital and Princess Máxima Center, Utrecht, the Netherlands
| | - Zachri N Ovadja
- Department of Plastic, Reconstructive, and Hand Surgery, University Medical Center Utrecht, Wilhelmina Children's Hospital and Princess Máxima Center, Utrecht, the Netherlands
| | - Caroline C C Hulsker
- Department of Pediatric Surgery, Princess Máxima Center, Utrecht, the Netherlands
| | | | | | - Emma C Paes
- Department of Plastic, Reconstructive, and Hand Surgery, University Medical Center Utrecht, Wilhelmina Children's Hospital and Princess Máxima Center, Utrecht, the Netherlands
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3
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Baccarani A, Filosso P, Marra C, De Maria F, Blessent CGF, Ruggiero C, Pappalardo M, Pedone A, De Santis G. Reconstruction of Complex Anterior Chest Wall Defects: The Lasagna Technique. PLASTIC AND RECONSTRUCTIVE SURGERY-GLOBAL OPEN 2023; 11:e5384. [PMID: 37964922 PMCID: PMC10642906 DOI: 10.1097/gox.0000000000005384] [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: 07/27/2023] [Accepted: 09/14/2023] [Indexed: 11/16/2023]
Abstract
Background Sternal tumors are rare, comprising only 0.94% of all bone tumors, with the majority being sarcomas. An extensive composite defect is often the result of surgical resection. Reconstruction of this anatomical area is a challenge for plastic surgeons. Reconstruction must fulfil two different tasks: restoration of soft tissues and stabilization of the chest wall. Both are well defined, and many techniques have been historically proposed. Methods We present the case of a 66-year-old man affected by sternal metastasis of lung non-small cell carcinoma with sarcomatoid features. After wide tumor resection, a large defect was created. Results The patient underwent a complex multilayer reconstruction that combined multiple techniques: Gore DualMesh to reconstruct the pericardial plane and protect the heart muscle, omental flap to facilitate integration of the mesh, titanium bars to recreate chest wall stability, and bilateral pectoralis muscle flaps to cover hardware. This multilayer reconstruction was named the "lasagna technique." Conclusions Due to the rarity of primary malignancies of the sternum, it is difficult to standardize a therapeutic approach. For this reason, it is necessary to customize the surgical treatment by combining several techniques and materials. Our lasagna technique may be considered a valuable option in treating these complex reconstructive cases.
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Affiliation(s)
- Alessio Baccarani
- From the Department of Plastic and Reconstructive Surgery, Azienda Ospedaliero-Universitaria di Modena, Università di Modena e Reggio Emilia, Modena, Italy
| | - Pierluigi Filosso
- Department of Thoracic Surgery, Azienda Ospedaliero-Universitaria di Modena, Università di Modena e Reggio Emilia, Modena, Italy
| | - Caterina Marra
- From the Department of Plastic and Reconstructive Surgery, Azienda Ospedaliero-Universitaria di Modena, Università di Modena e Reggio Emilia, Modena, Italy
| | - Federico De Maria
- From the Department of Plastic and Reconstructive Surgery, Azienda Ospedaliero-Universitaria di Modena, Università di Modena e Reggio Emilia, Modena, Italy
| | - Claudio Gio Francesco Blessent
- From the Department of Plastic and Reconstructive Surgery, Azienda Ospedaliero-Universitaria di Modena, Università di Modena e Reggio Emilia, Modena, Italy
| | - Ciro Ruggiero
- Department of Thoracic Surgery, Azienda Ospedaliero-Universitaria di Modena, Università di Modena e Reggio Emilia, Modena, Italy
| | - Marco Pappalardo
- From the Department of Plastic and Reconstructive Surgery, Azienda Ospedaliero-Universitaria di Modena, Università di Modena e Reggio Emilia, Modena, Italy
| | - Antonio Pedone
- From the Department of Plastic and Reconstructive Surgery, Azienda Ospedaliero-Universitaria di Modena, Università di Modena e Reggio Emilia, Modena, Italy
| | - Giorgio De Santis
- From the Department of Plastic and Reconstructive Surgery, Azienda Ospedaliero-Universitaria di Modena, Università di Modena e Reggio Emilia, Modena, Italy
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4
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Lo Iacono G, Mazzella A, Mohamed S, Petrella F, Sedda G, Casiraghi M, Girelli L, Bertolaccini L, Spaggiari L. The Role of Surgery in Primary Chest Wall Tumors: Over 20 Years’ Experience in Resection and Reconstruction. Cancers (Basel) 2023; 15:cancers15072153. [PMID: 37046813 PMCID: PMC10093177 DOI: 10.3390/cancers15072153] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2023] [Revised: 03/30/2023] [Accepted: 03/31/2023] [Indexed: 04/08/2023] Open
Abstract
Background: Primary chest wall tumors comprise a heterogeneous group of neoplasms arising from soft tissues and bones. While surgical excision is the standard of care for benign tumors, the management of malignant tumors requires multimodal treatment. We conducted a predictive analysis of outcome, recurrence-free and overall survival. Methods: We retrospectively reviewed the clinical and pathological records of all patients treated in our center between 1998 and 2020. Results: 53 patients (15–85 years) were treated in our department. The average tumor diameter was 65 ± 35 mm (10–160 mm). Negative margins were obtained in 48 patients (90.6%), whereas in the remaining 5, R1 resection was accomplished. Median overall survival was 63,03 months (1–282 months). Overall survival was 90% at 1 year, 78% at 2 years, and 61% at 5 years. Our analysis identified tumor diameter, postoperative complications, and high grade of malignancy as factors that can influence prognosis. Conclusions: The treatment of primary chest wall tumors remains a very challenging process. Different histological types preclude definition of an unequivocal approach. Complete resection with healthy margins remains a definitive cornerstone in the treatment of these cancers as part of a more comprehensive approach.
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Affiliation(s)
- Giorgio Lo Iacono
- Department of Thoracic Surgery, IEO, European Institute of Oncology IRCCS, 20141 Milan, Italy
| | - Antonio Mazzella
- Department of Thoracic Surgery, IEO, European Institute of Oncology IRCCS, 20141 Milan, Italy
| | - Shehab Mohamed
- Department of Thoracic Surgery, IEO, European Institute of Oncology IRCCS, 20141 Milan, Italy
| | - Francesco Petrella
- 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
| | - Giulia Sedda
- Department of Thoracic Surgery, IEO, European Institute of Oncology IRCCS, 20141 Milan, Italy
| | - Monica Casiraghi
- 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
| | - Lara Girelli
- Department of Thoracic Surgery, IEO, European Institute of Oncology IRCCS, 20141 Milan, Italy
| | - Luca Bertolaccini
- 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
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5
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Aramini B, Masciale V, Radaelli LFZ, Sgarzani R, Dominici M, Stella F. The sternum reconstruction: Present and future perspectives. Front Oncol 2022; 12:975603. [PMID: 36387077 PMCID: PMC9649912 DOI: 10.3389/fonc.2022.975603] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2022] [Accepted: 10/12/2022] [Indexed: 11/22/2022] Open
Abstract
Sternectomy is a procedure mainly used for removing tumor masses infiltrating the sternum or treating infections. Moreover, the removal of the sternum involves the additional challenge of performing a functional reconstruction. Fortunately, various approaches have been proposed for improving the operation and outcome of reconstruction, including allograft transplantation, using novel materials, and developing innovative surgical approaches, which promise to enhance the quality of life for the patient. This review will highlight the surgical approaches to sternum reconstruction and the new perspectives in the current literature.
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Affiliation(s)
- Beatrice Aramini
- Division of Thoracic Surgery, Department of Experimental, Diagnostic and Specialty Medicine—DIMES of the Alma Mater Studiorum, University of Bologna, G.B. Morgagni—L. Pierantoni Hospital, Forlì, Italy
- *Correspondence: Beatrice Aramini,
| | - Valentina Masciale
- Cell Therapy Laboratory, Department of Medical and Surgical Sciences, University of Modena and Reggio Emilia, Modena, Italy
| | - Lorenzo Federico Zini Radaelli
- Division of Thoracic Surgery, Department of Experimental, Diagnostic and Specialty Medicine—DIMES of the Alma Mater Studiorum, University of Bologna, G.B. Morgagni—L. Pierantoni Hospital, Forlì, Italy
| | - Rossella Sgarzani
- Center of Major Burns, Plastic Surgery Unit, Maurizio Bufalini Hospital, Cesena, Italy
| | - Massimo Dominici
- Cell Therapy Laboratory, Department of Medical and Surgical Sciences, University of Modena and Reggio Emilia, Modena, Italy
- Division of Oncology, Department of Medical and Surgical Sciences, University of Modena and Reggio Emilia, Modena, Italy
| | - Franco Stella
- Division of Thoracic Surgery, Department of Experimental, Diagnostic and Specialty Medicine—DIMES of the Alma Mater Studiorum, University of Bologna, G.B. Morgagni—L. Pierantoni Hospital, Forlì, Italy
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6
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Adereti C, Fabien J, Adereti J, Pierre-Louis M, Chacon D, Adereti V. Rib Plating as an Effective Approach to Managing Traumatic Rib Injuries: A Review of the Literature. Cureus 2022; 14:e29664. [DOI: 10.7759/cureus.29664] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/23/2022] [Indexed: 11/05/2022] Open
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7
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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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8
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Spardy J, Kornblith L, Elkbuli A. Surgical stabilization of iatrogenic rib fractures following cardiopulmonary resuscitation. Am J Emerg Med 2022; 59:195-197. [DOI: 10.1016/j.ajem.2022.05.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2022] [Revised: 05/06/2022] [Accepted: 05/14/2022] [Indexed: 11/27/2022] Open
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9
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Stowell JT, Walker CM, Chung JH, Bang TJ, Carter BW, Christensen JD, Donnelly EF, Hanna TN, Hobbs SB, Johnson BD, Kandathil A, Lo BM, Madan R, Majercik S, Moore WH, Kanne JP. ACR Appropriateness Criteria® Nontraumatic Chest Wall Pain. J Am Coll Radiol 2021; 18:S394-S405. [PMID: 34794596 DOI: 10.1016/j.jacr.2021.08.004] [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: 08/23/2021] [Accepted: 08/26/2021] [Indexed: 10/19/2022]
Abstract
Chest pain is a common reason that patients may present for evaluation in both ambulatory and emergency department settings, and is often of musculoskeletal origin in the former. Chest wall syndrome collectively describes the various entities that can contribute to chest wall pain of musculoskeletal origin and may affect any chest wall structure. Various imaging modalities may be employed for the diagnosis of nontraumatic chest wall conditions, each with variable utility depending on the clinical scenario. We review the evidence for or against use of various imaging modalities for the diagnosis of nontraumatic chest wall pain. The American College of Radiology Appropriateness Criteria are evidence-based guidelines for specific clinical conditions that are reviewed annually by a multidisciplinary expert panel. The guideline development and revision include an extensive analysis of current medical literature from peer reviewed journals and the application of well-established methodologies (RAND/UCLA Appropriateness Method and Grading of Recommendations Assessment, Development, and Evaluation or GRADE) to rate the appropriateness of imaging and treatment procedures for specific clinical scenarios. In those instances where evidence is lacking or equivocal, expert opinion may supplement the available evidence to recommend imaging or treatment.
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Affiliation(s)
| | | | | | - Jonathan H Chung
- Panel Chair; and Vice-Chair, Quality and Section Chief, Chest Imaging, Department of Radiology, University of Chicago, Chicago, Illinois
| | - Tami J Bang
- Co-Director, Cardiothoracic Imaging Fellowship Committee, University of Colorado School of Medicine, Anschutz Medical Campus, Aurora, Colorado; Co-Chair, membership committee, NASCI; and Membership committee, ad-hoc online content committee, STR
| | - Brett W Carter
- The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Jared D Christensen
- Vice-Chair, Department of Radiology, Duke University Medical Center, Durham, North Carolina; and Chair, Lung-RADS
| | - Edwin F Donnelly
- Chief, Thoracic Imaging, Ohio State University, Columbus, Ohio; Co-Chair Physics Module Committee, RSNA
| | - Tarek N Hanna
- Associate Director, Emergency and Trauma Imaging, Emory University, Atlanta, Georgia; and Director-at-Large, American Society of Emergency Radiology
| | - Stephen B Hobbs
- Vice-Chair, Informatics and Integrated Clinical Operations and Division Chief, Cardiovascular and Thoracic Radiology, University of Kentucky, Lexington, Kentucky
| | | | | | - Bruce M Lo
- Sentara Norfolk General/Eastern Virginia Medical School, Norfolk, Virginia; and Board Member, American College of Emergency Physicians
| | - Rachna Madan
- Associate Fellowship Director, Division of Thoracic Imaging, Brigham & Women's Hospital, Boston, Massachusetts
| | - Sarah Majercik
- Vice-Chair, Surgery for Research and Director, Trauma Research, Intermountain Medical Center, Salt Lake City, Utah; and American Association for the Surgery of Trauma
| | - William H Moore
- Associate Chair, Clinical Informatics and Chief, Thoracic Imaging, New York University Langone Medical Center, New York, New York
| | - Jeffrey P Kanne
- Specialty Chair, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin
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10
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Topolnitskiy E, Chekalkin T, Marchenko E, Yasenchuk Y, Kang SB, Kang JH, Obrosov A. Evaluation of Clinical Performance of TiNi-Based Implants Used in Chest Wall Repair after Resection for Malignant Tumors. J Funct Biomater 2021; 12:jfb12040060. [PMID: 34842727 PMCID: PMC8628886 DOI: 10.3390/jfb12040060] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2021] [Revised: 11/06/2021] [Accepted: 11/08/2021] [Indexed: 12/14/2022] Open
Abstract
In this study, we assessed the outcomes after surgical treatment of thoracic post-excision defects in 15 patients, using TiNi knitted surgical meshes and customized artificial TiNi-based ribs. Methods: Eight patients were diagnosed with advanced non-small cell lung cancer (NSCLC) invading the chest wall, of which five patients were T3N0M0, two were T3N1M0, and one was T3N2M0. Squamous cell carcinoma was identified in three of these patients and adenocarcinoma in five. In two cases, chest wall resection and repair were performed for metastases of kidney cancer after radical nephrectomy. Three-dimensional CT reconstruction and X-ray scans were used to plan the surgery and customize the reinforcing TiNi-based implants. All patients received TiNi-based devices and were prospectively followed for a few years. Results: So far, there have been no lethal outcomes, and all implanted devices were consistent in follow-up examinations. Immediate complications were noted in three cases (ejection of air through the pleural drains, paroxysm of atrial fibrillation, and pleuritis), which were conservatively managed. In the long term, no complications, aftereffects, or instability of the thoracic cage were observed. Conclusion: TiNi-based devices used for extensive thoracic lesion repair in this context are promising and reliable biomaterials that demonstrate good functional, clinical, and cosmetic outcomes.
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Affiliation(s)
- Evgeniy Topolnitskiy
- Laboratory of Medical Materials, Tomsk State University, 634045 Tomsk, Russia; (E.T.); (E.M.); (Y.Y.); (A.O.)
- Department of Surgery, Siberian State Medical University, 634050 Tomsk, Russia
| | - Timofey Chekalkin
- Laboratory of Medical Materials, Tomsk State University, 634045 Tomsk, Russia; (E.T.); (E.M.); (Y.Y.); (A.O.)
- R&D Center, TiNiKo Co., Ochang 28119, Korea;
- Correspondence:
| | - Ekaterina Marchenko
- Laboratory of Medical Materials, Tomsk State University, 634045 Tomsk, Russia; (E.T.); (E.M.); (Y.Y.); (A.O.)
| | - Yuri Yasenchuk
- Laboratory of Medical Materials, Tomsk State University, 634045 Tomsk, Russia; (E.T.); (E.M.); (Y.Y.); (A.O.)
| | - Seung-Baik Kang
- Boramae Medical Center, Seoul National University Hospital, Seoul 07061, Korea;
| | | | - Aleksei Obrosov
- Laboratory of Medical Materials, Tomsk State University, 634045 Tomsk, Russia; (E.T.); (E.M.); (Y.Y.); (A.O.)
- Department of Physical Metallurgy and Materials Technology, Brandenburg University of Technology, 03-046 Cottbus, Germany
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11
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Nardi WS, Buero A, Pankl L, Quildrian SD. En-bloc resection of soft-tissue sarcoma of anterior chest wall and reconstruction with titanium bars and free anterolateral thigh flap. BMJ Case Rep 2021; 14:14/7/e241603. [PMID: 34266816 DOI: 10.1136/bcr-2021-241603] [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: 11/04/2022] Open
Abstract
Primary soft-tissue sarcomas (STSs) of the chest wall are uncommon. Complete surgical resection remains the mainstay of treatment being sternal resection ocassionally required. We present a 25-year-old man with an anterior chest wall STS. The patient underwent complete oncological resection with reconstruction using titanium bars combined with a free vascularised anterolateral thigh flap. STSs of the chest wall are very rare and they comprise a surgical challenge for both resection and reconstruction.
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Affiliation(s)
- Walter Sebastián Nardi
- Sarcoma and Melanoma Unit - General Surgery Department, Hospital Britanico de Buenos Aires, Buenos Aires, Argentina
| | - Agustin Buero
- Thoracic Surgery Department, Hospital Británico de Buenos Aires, Buenos Aires, Argentina
| | - Leonardo Pankl
- Thoracic Surgery Department, Hospital Británico de Buenos Aires, Buenos Aires, Argentina
| | - Sergio Damián Quildrian
- Sarcoma and Melanoma Unit - General Surgery Department, Hospital Britanico de Buenos Aires, Buenos Aires, Argentina
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12
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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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13
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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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14
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Schroeder-Finckh A, Lopez-Pastorini A, Galetin T, Stoelben E, Koryllos A. [Chest Wall Reconstruction Using Polypropylene Mesh: a Single-Center 8-Year Analysis]. Zentralbl Chir 2020; 146:329-334. [PMID: 32629509 DOI: 10.1055/a-1180-9621] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
BACKGROUND Chest wall resection for malignant tumours is usually combined with reconstruction of the bony defect. We analysed our single centre, 8-year, experience using polypropylene mesh for chest wall reconstruction. The goal of our retrospective study was to identify material-related complications and to compare them with the existing literature. METHODS The inclusion criterion in our retrospective cohort was a full-thickness chest wall excision and reconstruction using a polypropylene mesh with a mainly oncological indication spectrum (e.g. sarcomas, metastases, lung carcinomas with infiltration of the chest wall) in the period from January 2008 to January 2017. Primary endpoints were material-related complications: local infection, seroma, material migration, mesh explantation and chest wall instability. Secondary endpoints were the following postoperative complications: pneumonia, acute respiratory distress syndrome (ARDS), postoperative bleeding and prolonged postoperative ventilation (> 24 h postoperatively). RESULTS A total of 202 chest wall resections were performed in our clinic over a period of 8 years. Of these, 138 defects were reconstructed using a polypropylene mesh. Pneumonia was the most common postoperative complication at a rate of 12.3%. In 5.7% of the cases, a wound seroma developed that made it necessary to insert a Redon suction drain. Local wound infection was confirmed microbiologically in three cases (2.1%). In one of these cases, the reconstruction material had to be removed. The 30-day mortality rate was 1.4% with two postoperative deaths. Material migration or chest wall instability with a paradoxical pattern of breathing movement were not documented. CONCLUSION Chest wall reconstruction using polypropylene mesh is a technique with low material-related complication rate. The low rate of local infections, material explantation, and chest instability documented in our cohort can be a helpful decision factor for the operating thoracic surgeon looking for the appropriate reconstruction material.
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Affiliation(s)
- Alexander Schroeder-Finckh
- Lungenklinik, Lehrstuhl für Thoraxchirurgie, Universität Witten/Herdecke, Kliniken der Stadt Köln gGmbH, Deutschland
| | - Alberto Lopez-Pastorini
- Lungenklinik, Lehrstuhl für Thoraxchirurgie, Universität Witten/Herdecke, Kliniken der Stadt Köln gGmbH, Deutschland
| | - Thomas Galetin
- Lungenklinik, Lehrstuhl für Thoraxchirurgie, Universität Witten/Herdecke, Kliniken der Stadt Köln gGmbH, Deutschland
| | - Erich Stoelben
- Lungenklinik, Lehrstuhl für Thoraxchirurgie, Universität Witten/Herdecke, Kliniken der Stadt Köln gGmbH, Deutschland
| | - Aris Koryllos
- Lungenklinik, Lehrstuhl für Thoraxchirurgie, Universität Witten/Herdecke, Kliniken der Stadt Köln gGmbH, Deutschland
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15
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Butano V, Zebley JA, Sarani B. Current Status of Rib Plating: Hardware Failure When and How? CURRENT SURGERY REPORTS 2020. [DOI: 10.1007/s40137-020-00257-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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16
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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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17
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Jian X, Lei W, Yuyang P, Yongdong X. A new instrument for surgical stabilization of multiple rib fractures. J Int Med Res 2019; 48:300060519877076. [PMID: 31566050 PMCID: PMC7607199 DOI: 10.1177/0300060519877076] [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] [Indexed: 11/21/2022] Open
Abstract
Objective Rib fixation is an effective treatment for patients with multiple rib
fractures. We retrospectively evaluated the application of a four-claw
titanium plate in patients with rib fractures. Methods Fifty-four patients treated for multiple rib fractures in our hospital from
2012 to 2016 were divided into a surgery group (n = 27) and conservative
treatment group (n = 27). The patients’ age, sex, cause of fracture, Injury
Severity Score, chest Abbreviated Injury Scale score, number of ventilator
days, and length of hospitalization were recorded. Results The mean duration of mechanical ventilation was 4.5 ± 0.7 and 7.9 ± 1.7 days
in the surgery and control group, respectively, with a significant
difference. The length of intensive care unit stay was also significantly
different between the groups (5.9 ± 0.6 vs. 10.6 ± 1.9 days, respectively).
The length of hospital stay and recovery time to regular life in the surgery
and control group were 11.5 ± 1.9 and 3.9 ± 4.0 days and 38.2 ± 8.3 and
60.8 ± 12.1 days, respectively, both with significant differences. Conclusion A four-claw titanium plate is valuable for patients with multiple rib
fractures, allowing easy fixation of broken ribs beneath the scapula, even
the second rib.
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Affiliation(s)
- Xiong Jian
- Department of Thoracic Surgery, Shanghai Pudong Hospital, Fudan University Pudong Medical Center, Pudong, Shanghai, China
| | - Wu Lei
- Department of Thoracic Surgery, Shanghai Pudong Hospital, Fudan University Pudong Medical Center, Pudong, Shanghai, China
| | - Pi Yuyang
- Department of Thoracic Surgery, Shanghai Pudong Hospital, Fudan University Pudong Medical Center, Pudong, Shanghai, China
| | - Xu Yongdong
- Department of Thoracic Surgery, Shanghai Pudong Hospital, Fudan University Pudong Medical Center, Pudong, Shanghai, China
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18
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Elbawab H, Alreshaid F, Hashem T, Alnasser A, Husain R, Aljehani Y. Intercostal hemangioma: Case report of a rare chest wall tumor in childhood. Int J Surg Case Rep 2019; 60:319-322. [PMID: 31280064 PMCID: PMC6612705 DOI: 10.1016/j.ijscr.2019.06.026] [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: 04/07/2019] [Revised: 06/10/2019] [Accepted: 06/13/2019] [Indexed: 01/30/2023] Open
Abstract
Intercostal hemangioma is an extremely rare disease, accounting for approximately 0.01% of all benign hemangiomas. Hemangiomas are prone to bleed spontaneously or after minor traumatic injury. Complete excision of the tumor is mandatory even after embolization to prevent recruitment of a collatera1 blood supply.
Introduction Intercostal hemangioma is an extremely rare disease. It is difficult to distinguish intercostal hemangioma from other chest wall tumors. The difficulty in preoperative diagnosis may result in incomplete surgical resection and hence a high rate of recurrence. Case presentation A 14-year-old boy who presented with asymptomatic right lateral chest wall mass with no history of trauma. Different radiological modalities were employed for diagnosis including computed tomography (CT) showed a soft tissue mass 6.5 × 4 × 5.6 cm in size abutting 5th and 6th ribs. Magnetic resonance imaging (MRI) revealed iso-intense signal in T1 and hyperintense signal in T2, that is higher than that of adjacent muscles in the inferolateral right chest wall which was compatible with intercostal hemangioma. The patient underwent surgery for excision of the mass. Through right posterolateral thoracotomy, there was a well-demarcated mass abutting 5th, and 6th ribs filling the right 5th interspaces. Histopathological examination confirmed the diagnosis of intercostal hemangioma. Discussion Chest wall hemangiomas are uncommon and mostly arise outside the rib cage. Hemangiomas rarely occur in the intercostal space, and most of these originate from intercostal muscles (Agarwal et al., 2006). Watson and McCarthy postulated two theories for the etiology of hemangiomas. The more widely supported theory claims that hemangiomas are of congenital origin. The other theory proposes a traumatic origin of hemangiomas. Conclusion Complete surgical resection should not be compromised by the resultant chest wall defect to prevent recurrence.
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Affiliation(s)
- Hatem Elbawab
- Division of General Thoracic Surgery, Department of Surgery, King Fahad Hospital of the University, College of Medicine, Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia.
| | - Farouk Alreshaid
- Division of General Thoracic Surgery, Department of Surgery, King Fahad Hospital of the University, College of Medicine, Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia
| | - Tariq Hashem
- Department of Pathology, King Fahad Hospital of the University, College of Medicine, Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia
| | - Asayil Alnasser
- Division of General Thoracic Surgery, Department of Surgery, King Fahad Hospital of the University, College of Medicine, Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia
| | - Raja Husain
- Division of General Thoracic Surgery, Department of Surgery, King Fahad Hospital of the University, College of Medicine, Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia
| | - Yasser Aljehani
- Division of General Thoracic Surgery, Department of Surgery, King Fahad Hospital of the University, College of Medicine, Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia
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19
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Hostetler ZS, Stitzel JD, Weaver AA. Comparing rib cortical thickness measurements from computed tomography (CT) and Micro-CT. Comput Biol Med 2019; 111:103330. [PMID: 31276944 DOI: 10.1016/j.compbiomed.2019.103330] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2019] [Revised: 06/13/2019] [Accepted: 06/13/2019] [Indexed: 11/26/2022]
Abstract
BACKGROUND The objective of this study was to compare cortical thickness of rib specimens scanned with clinical computed tomography (clinical-CT) at 0.5 and 1.0 mm slice thickness versus micro-CT at 0.05 mm slice thickness. Cortical thickness variation and accuracy was explored by anatomical region (anterior vs. lateral) and cross-sectional quadrants (superior, interior, inferior, and exterior). METHODS A validated cortical thickness algorithm was applied to clinical-CT and micro-CT scans of 17 rib specimens from six male post mortem human subjects aged 42-81 years. Each rib specimen was segmented and the thickness measurements were partitioned into cross-sectional quadrants in the anterior and lateral regions of the rib. Within each rib quadrant, the following were calculated: average thickness ± standard deviation, mean thickness difference between clinical-CT and micro-CT, and a thickness ratio between clinical-CT and micro-CT. Correlations from linear regression and paired-t tests were determined for paired clinical-CT and micro-CT results. RESULTS On average, the 0.5 mm clinical-CT underestimated the micro-CT thickness by 0.005 mm, while the 1.0 mm clinical-CT overestimated the micro-CT thickness by 0.149 mm. Thickness derived from 0.5 mm clinical-CT showed greater significant linear correlations (p < 0.05) with micro-CT thickness compared to 1.0 mm clinical-CT. CONCLUSIONS The small mean differences and thickness ratios near 1 show validation for the cortical thickness algorithm when applied to rib clinical-CT scans. Using clinical-CT scans as way to accurately measure rib cortical thickness offers a non-invasive way to analyze millions of CT scans collected each year from males and females of all ages.
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Affiliation(s)
- Zachary S Hostetler
- Wake Forest University School of Medicine, Biomedical Engineering, 575 N. Patterson Ave., Winston-Salem, NC, 27101, USA.
| | - Joel D Stitzel
- Wake Forest University School of Medicine, Biomedical Engineering, 575 N. Patterson Ave., Winston-Salem, NC, 27101, USA.
| | - Ashley A Weaver
- Wake Forest University School of Medicine, Biomedical Engineering, 575 N. Patterson Ave., Winston-Salem, NC, 27101, USA.
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20
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Xiong M, Hu W, Lou Q, Yin S, Wang X. Efficacy of nickel-titanium memory alloy in the treatment of multiple rib fracture combined with sternal fracture. Exp Ther Med 2019; 18:537-542. [PMID: 31258691 PMCID: PMC6566122 DOI: 10.3892/etm.2019.7597] [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: 01/21/2019] [Accepted: 05/16/2019] [Indexed: 11/05/2022] Open
Abstract
Clinical efficacy and complications of nickel-titanium memory alloy in the treatment of multiple rib fractures combined with sternal fractures was investigated. A retrospective analysis of 123 patients with multiple rib fractures combined with sternal fractures admitted to First People's Hospital of Fuzhou from January 2013 to December 2015 was performed, including study group (treated with internal fixation by the nickel-titanium memory alloy, n=68) and control group (treated with internal fixation by partial pressure bandage, n=55). Μean arterial pressure (MAP), heart rate (HR), and visual analogue pain score (VAS) of the two groups before and after treatment were compared and analyzed. No significant difference in MAP, HR and VAS scores between groups was detected before treatment (P>0.05). After treatment, MAP score of study group was significantly higher, and HR and VAS scores were significantly lower (P<0.05). Μethod of internal fixation by the nickel-titanium memory alloy, with better efficacy than the traditional method of internal fixation by partial pressure bandage and less postoperative complications in the treatment of flail chest caused by multiple rib fractures combined with sternal fractures, is worthy of clinical application and promotion.
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Affiliation(s)
- Ming Xiong
- Department of Cardiothoracic Surgery, First People's Hospital of Fuzhou, Fuzhou, Jiangxi 344000, P.R. China
| | - Wei Hu
- Department of Cardiothoracic Surgery, First People's Hospital of Fuzhou, Fuzhou, Jiangxi 344000, P.R. China
| | - Qiang Lou
- Department of Cardiothoracic Surgery, First People's Hospital of Fuzhou, Fuzhou, Jiangxi 344000, P.R. China
| | - Shi Yin
- Department of ICU, First People's Hospital of Fuzhou, Fuzhou, Jiangxi 344000, P.R. China
| | - Xin Wang
- Department of Thoracic Surgery, Xuzhou Central Hospital, Xuzhou, Jiangsu 221000, P.R. China
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21
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Surgical Repair of the Postoperative Lung Hernia by Combining Mesh Interposition and Chest Wall Stabilization by Using Synthes Plates: A Novel Technique. Case Rep Surg 2019; 2019:2107083. [PMID: 31093412 PMCID: PMC6476009 DOI: 10.1155/2019/2107083] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2018] [Revised: 02/20/2019] [Accepted: 03/10/2019] [Indexed: 11/19/2022] Open
Abstract
Several technical points for postoperative lung hernia repair are still not fully elucidated. We present an original technical solution to deal with this complication. In a 68-year-old female, the lung hernia was confirmed 5 months after the partial left-sided chest wall and scapula angle resection with primary Mersilene mesh reconstruction for elastofibroma. The patient refused the proposed surgical correction, being only slightly limited in daily activities. The symptoms persisted under analgetic therapy till the moment when patient's daily activities became critically limited, 22 months after surgery. The repeated chest CT showed a slight increase in hernia size with no signs of tumour recurrence, so that reoperation was planned. After the exposure of the mesh region, a lung protrusion (4 × 3 cm) along the anterolateral edge of the mesh was confirmed. By careful dissection, the mesh was separated from a firmly adherent lung and removed. After adhaesiolysis and complete lung liberation, a wedge resection of the afunctional lung tissue of the lingula was done, just in the region of contact with the mesh. After the chest tube insertion, the chest wall defect was reconstructed by using a Mersilene mesh, and the final chest wall stabilization was done by the fixation of two Synthes plates (DePuy Synthes J&J) over the 5th and 6th ribs. The postoperative course was uneventful. One year after the operation, the patient was in good general condition, without the need for analgesics. To the best of our knowledge, the described technique is the original way of dealing with postoperative lung hernia. We find it efficient as a prevention of potential serious hernia-related complications.
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22
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Shah VN, Orlov O, Hoffman R, Plestis K. Reoperation 7 years after sternal reconstruction with a porcine acellular dermal matrix. Eur J Cardiothorac Surg 2018; 54:601-603. [PMID: 29490047 DOI: 10.1093/ejcts/ezy055] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/23/2017] [Accepted: 01/28/2018] [Indexed: 11/13/2022] Open
Abstract
The number of chest wall reconstructions with a biologic mesh is increasing, but its long-term durability is unproven. A 73-year-old man underwent a complex sternal reconstruction 7 years ago with porcine acellular dermal matrix after postoperative repair of his ruptured right ventricle after coronary artery bypass grafting. He recently presented with unstable angina. Cardiac catheterization showed occluded saphenous vein grafts, and the patient required repeat coronary artery bypass grafting. Upon re-entry into the chest, the mesh was completely incorporated into the surrounding tissues and maintained long-term durability.
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Affiliation(s)
- Vishal N Shah
- Lankenau Institute for Medical Research, Lankenau Medical Center, Wynnewood, PA, USA.,Department of Cardiothoracic Surgery, Lankenau Medical Center, Wynnewood, PA, USA
| | - Oleg Orlov
- Lankenau Institute for Medical Research, Lankenau Medical Center, Wynnewood, PA, USA.,Department of Cardiothoracic Surgery, Lankenau Medical Center, Wynnewood, PA, USA
| | - Ryan Hoffman
- Department of Plastic and Reconstructive Surgery, Lankenau Medical Center, Wynnewood, PA, USA
| | - Konstadinos Plestis
- Department of Cardiothoracic Surgery, Lankenau Medical Center, Wynnewood, PA, USA
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23
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Ong K, Ong CS, Chua YC, Fazuludeen AA, Ahmed ADB. The painless combination of anatomically contoured titanium plates and porcine dermal collagen patch for chest wall reconstruction. J Thorac Dis 2018; 10:2890-2897. [PMID: 29997954 DOI: 10.21037/jtd.2018.04.116] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Abstract
Background A plethora of new biomaterials and dedicated rib fixator implant systems have been introduced into the field of chest wall reconstruction. The aim of our study is to evaluate the surgical outcomes of a novel combination of the anatomically contoured titanium rib implant and porcine dermal collagen patch for chest wall reconstruction. Methods We performed a retrospective review of eight consecutive patients who underwent chest wall resection and reconstruction between January 2014 to August 2015 in a single institution. MatrixRib Fixation System and Permacol Surgical Implant were utilized to achieve chest wall reconstruction. Results The indication for reconstruction was malignant infiltration in 50% of patients. Three other subjects (37.5%) had chest wall resections to achieve adequate and safe surgical exposure. One patient had a right lung apical mycetoma with chest wall invasion. All patients underwent lung resections with the removal of 2 to 6 (median 3) ribs. Reconstruction was performed using the MatrixRib system, with a median of 2.5 (range, 2-4) ribs fixed in each patient. There was no post-operative mortality. One patient had a superficial wound infection which resolved with one week of oral antibiotics. Upon discharge, the pain scores were near zero with minimal analgesic requirements. None of the patients required repeat surgery or removal of their implants. Conclusions Our early experience indicates that the combination of the MatrixRib system and Permacol patch for chest wall reconstruction is safe and feasible with promising results in terms of anatomical restoration of the chest wall mechanics, infection and pain.
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Affiliation(s)
- Kingsfield Ong
- Division of Thoracic Surgery, Department of General Surgery, Tan Tock Seng Hospital, Singapore
| | - Chin Siang Ong
- Johns Hopkins School of Medicine, Baltimore, Maryland, USA
| | - Yang Chong Chua
- Division of Surgical Oncology, National Cancer Centre, Singapore
| | - Ali Akbar Fazuludeen
- Division of Thoracic Surgery, Department of General Surgery, Tan Tock Seng Hospital, Singapore
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Dudek W, Schreiner W, Horch RE, Sirbu H. Sternal resection and reconstruction for secondary malignancies. J Thorac Dis 2018; 10:4230-4235. [PMID: 30174868 DOI: 10.21037/jtd.2018.06.18] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Background Limited data on sternal and/or anterior chest wall resections for secondary malignancies exist. The purpose of this study was to examine the perioperative outcomes and postoperative overall survival (OS) in patients who underwent sternal and/or anterior chest wall resections for secondary sternal tumors (SSTs). Methods A retrospective analysis of all patients who underwent resection of SSTs at single institution between 2000 and 2016 has been performed. OS was estimated using the Kaplan-Meier method. Results Ten patients underwent sternal and/or anterior chest wall resection for SSTs with curative (70%) or palliative (30%) intent. Two (20%) patients underwent complete and 8 (80%) partial sternal and/or anterior chest wall resection. There were no perioperative deaths, major complications occurred in 3 (30%) patients. Tumor resection was complete (R0) in 5 (50%) patients. The 5-year OS rate was 40%. No OS difference in R0 vs. R1 resections was observed. Conclusions Sternal and/or anterior chest wall resections for SSTs can be performed with low morbidity and mortality. Complete SST resection does not assure favorable OS. Sternal resections can be considered palliative treatment option in patients with stable stage IV disease with isolated sternal involvement.
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Affiliation(s)
- Wojciech Dudek
- Department of Thoracic Surgery, University Hospital Erlangen, Friedrich-Alexander University Erlangen-Nuremberg, Erlangen, Germany
| | - Waldemar Schreiner
- Department of Thoracic Surgery, University Hospital Erlangen, Friedrich-Alexander University Erlangen-Nuremberg, Erlangen, Germany
| | - Raymund E Horch
- Department of Plastic and Hand Surgery, University Hospital Erlangen, Friedrich-Alexander University Erlangen-Nuremberg, Erlangen, Germany
| | - Horia Sirbu
- Department of Thoracic Surgery, University Hospital Erlangen, Friedrich-Alexander University Erlangen-Nuremberg, Erlangen, Germany
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Kang J, Wang L, Yang C, Wang L, Yi C, He J, Li D. Custom design and biomechanical analysis of 3D-printed PEEK rib prostheses. Biomech Model Mechanobiol 2018; 17:1083-1092. [PMID: 29730771 DOI: 10.1007/s10237-018-1015-x] [Citation(s) in RCA: 42] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2017] [Accepted: 04/02/2018] [Indexed: 11/29/2022]
Abstract
A tumour resection normally involves a large tissue resection and bone replacement. Polyether ether ketone (PEEK) has become a suitable candidate for use in various prostheses owing to its lightness in weight, modulus close to that of natural bone, and good biocompatibility, among other factors. This study proposes a new design method for a rib prosthesis using the centroid trajectory of the natural replaced rib, where the strength can be adjusted by monitoring the cross-sectional area, shape, and properties. A custom-designed rib prosthesis was manufactured using fused deposition modelling (FDM) manufacturing technology, and the mechanical behaviour was found to be close to that of a natural rib. A finite element analysis of the designed rib was carried out under similar loading conditions to those used in mechanical testing. The results indicate that the centroid trajectory derived from a natural rib diaphysis can provide reliable guidance for the design of a rib prosthesis. Such methodology not only offers considerable design freedom in terms of shape and required strength, but also benefits the quality of the surface finishing for samples manufactured using the FDM technique. FDM-printed PEEK rib prostheses have been successfully implanted, and good clinical performances have been achieved.
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Affiliation(s)
- Jianfeng Kang
- State Key Laboratory for Manufacturing Systems Engineering, Xi'an Jiaotong University, Xi'an, Shaan Xi, China
| | - Ling Wang
- State Key Laboratory for Manufacturing Systems Engineering, Xi'an Jiaotong University, Xi'an, Shaan Xi, China.
| | - Chuncheng Yang
- State Key Laboratory for Manufacturing Systems Engineering, Xi'an Jiaotong University, Xi'an, Shaan Xi, China
| | - Lei Wang
- Departments of Thoracic Surgery, Tangdu Hospital, The Fourth Military Medical University, Xi'an, Shaan Xi, China
| | - Cao Yi
- State Key Laboratory for Manufacturing Systems Engineering, Xi'an Jiaotong University, Xi'an, Shaan Xi, China
| | - Jiankang He
- State Key Laboratory for Manufacturing Systems Engineering, Xi'an Jiaotong University, Xi'an, Shaan Xi, China
| | - Dichen Li
- State Key Laboratory for Manufacturing Systems Engineering, Xi'an Jiaotong University, Xi'an, Shaan Xi, China
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Abstract
PURPOSE OF REVIEW Renewed interest in surgical fixation of rib fractures has emerged. However, conservative treatment is still preferred at most surgical departments. We wanted to evaluate whether operative treatment of rib fractures may benefit severely injured patients. RECENT FINDINGS Several studies report a reduction in mechanical ventilation time, ICU length of stay (LOS), hospital LOS, pneumonia, need for tracheostomy, pain and costs in operatively treated patients with multiple rib fractures compared with patients treated nonoperatively. Although patient selection and timing of the operation seem crucial for successful outcome, no consensus exists. Mortality reduction has only been shown in a few studies. Most studies are retrospective cohort and case-control studies. Only four randomized control trials exist. SUMMARY Conservative treatment, consisting of respiratory assistance and pain control, is still the treatment of choice in the vast majority of patients with multiple rib fractures. In selected patients, operative fixation of fractured ribs within 72 h postinjury may lead to better outcome. More randomized control trials are needed to further determine who benefits from surgical fixation of rib fractures.
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Chiappetta M, Facciolo F. Sternum reconstruction using titanium plates matched with "sandwich" Gore-Tex meshes. J Vis Surg 2018; 4:47. [PMID: 29682457 DOI: 10.21037/jovs.2018.02.12] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2018] [Accepted: 02/02/2018] [Indexed: 11/06/2022]
Abstract
Chest wall reconstruction after extensive resection may be technically difficult, and which technique permits to obtain the right compromise between rigidity and plasticity of the chest wall is still argument of debate. Indeed, many techniques and materials have been proposed and tested to cover chest wall defects and to ensure correct respiratory movements, but unique results still miss. We herein report the case of a 55-years old woman with soft-tissue sarcoma involving the sternum treated with sternum and anterior ribs arch resection (from the second to the fourth). The chest wall defect was repaired using titanium plates and Gore-Tex meshes combined as a "sandwich". The scope was to obtain a synchronous movement of the prosthesis with the titanium ribs, reducing the scratching between the different materials and avoiding paradox chest wall movements.
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Affiliation(s)
- Marco Chiappetta
- Thoracic Surgery, Università Cattolica del Sacro Cuore, Fondazione Policlinico Universitario A.Gemelli, Rome, Italy.,Department of Surgical Oncology, Thoracic Surgery Unit, Regina Elena National Cancer Institute, IFO, Rome, Italy
| | - Francesco Facciolo
- Department of Surgical Oncology, Thoracic Surgery Unit, Regina Elena National Cancer Institute, IFO, Rome, Italy
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Sanna S, Brandolini J, Pardolesi A, Argnani D, Mengozzi M, Dell'Amore A, Solli P. Materials and techniques in chest wall reconstruction: a review. J Vis Surg 2017; 3:95. [PMID: 29078657 DOI: 10.21037/jovs.2017.06.10] [Citation(s) in RCA: 83] [Impact Index Per Article: 11.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2017] [Accepted: 06/15/2017] [Indexed: 01/22/2023]
Abstract
Extensive chest wall resection and reconstruction are a challenging procedure that requires a multidisciplinary approach, including input from thoracic surgeon, plastic surgeon and oncologist. In particular chest wall neoplastic pathology is associated with high surgical morbidity and can result in full thickness defects hard to reconstruct. The goals of a successful chest wall reconstruction are to restore the chest wall rigidity, preserve pulmonary mechanic and protect the intrathoracic organs minimizing the thoracic deformity. In case of large full thickness defects synthetic, biologic or composite meshes can be used, with or without titanium plate to restore thoracic cage rigidity as like as more recently the use of allograft to reconstruct the sternum. After skeletal stability is established full tissue coverage can be achieved using direct suture, skin graft or local advancement flaps, pedicled myocutaneous flaps or free flaps. The aim of this article is to illustrate the indications, various materials and techniques for chest wall reconstruction with the goal to obtain the best chest wall rigidity and soft tissue coverage.
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Affiliation(s)
- Stefano Sanna
- Thoracic Surgery Unit, G. B. Morgagni Hospital, Forli, Italy
| | - Jury Brandolini
- Thoracic Surgery Unit, G. B. Morgagni Hospital, Forli, Italy
| | | | | | - Marta Mengozzi
- Thoracic Surgery Unit, G. B. Morgagni Hospital, Forli, Italy
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Singh M, Kobraei EM, Nuutila K, Wee JO, Caterson EJ. Delayed haemothorax and fracture of titanium plate rib fixation following oncologic chest wall reconstruction. ANZ J Surg 2017; 89:E28-E30. [PMID: 28470673 DOI: 10.1111/ans.13963] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2016] [Revised: 11/21/2016] [Accepted: 02/06/2017] [Indexed: 12/01/2022]
Affiliation(s)
- Mansher Singh
- Division of Plastic Surgery, Department of Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Edward M Kobraei
- Division of Plastic Surgery, Department of Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Kristo Nuutila
- Division of Plastic Surgery, Department of Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Jon O Wee
- Division of Thoracic Surgery, Department of Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Edward J Caterson
- Division of Plastic Surgery, Department of Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
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Chest wall reconstruction using steel wire in a case of Chondrosarcoma Rib: a novel technique of neo-rib. Indian J Thorac Cardiovasc Surg 2017. [DOI: 10.1007/s12055-017-0493-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
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Consensus statement: Surgical stabilization of rib fractures rib fracture colloquium clinical practice guidelines. Injury 2017; 48:307-321. [PMID: 27912931 DOI: 10.1016/j.injury.2016.11.026] [Citation(s) in RCA: 148] [Impact Index Per Article: 21.1] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/13/2016] [Revised: 11/05/2016] [Accepted: 11/21/2016] [Indexed: 02/02/2023]
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Zhao ZR, Li Z, Situ DR, Ng CSH. Recent clinical innovations in thoracic surgery in Hong Kong. J Thorac Dis 2016; 8:S618-26. [PMID: 27651937 DOI: 10.21037/jtd.2016.03.93] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Abstract
The concept of personalized medicine, which aims to provide patients with targeted therapies while greatly reducing surgical trauma, is gaining popularity among Asian clinicians. Single port video-assisted thoracic surgery (VATS) has rapidly gained popularity in Hong Kong for major lung resections, despite bringing new challenges such as interference between surgical instruments and insertion of the optical source through a single incision. Novel types of endocutters and thoracoscopes can help reduce the difficulties commonly encountered during single-port VATS. Our region has been the testing ground and has led the development of many of these innovations. Performing VATS, in particular single-port VATS in hybrid operating theatre helps to localise small pulmonary lesions with real-time images, thus increasing surgical accuracy and pushes the boundaries in treating subcentimeter diseases. Such approach may be assisted by use of electromagnetic navigational bronchoscopy in the same setting. In addition, sublobar resection can also be more individualised according to pathologic tumour subtype that require rapid intraoperative diagnostic test to guide appropriate surgical therapy. A focus on technology and innovation for large tumours that require chest wall resection and reconstructions have also been on going, with new materials and prostheses that may be tailored to each individual needs. The current paper reviews the literature pertaining to the above topics and discusses recent related innovations in Hong Kong, highlighting the study results and future perspectives.
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Affiliation(s)
- Ze-Rui Zhao
- Department of Surgery, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong SAR, China
| | - Zheng Li
- Institute of Digestive Disease, Chow Yuk Ho Technology Centre for Innovative Medicine, The Chinese University of Hong Kong, Hong Kong SAR, China
| | - Dong-Rong Situ
- State Key Laboratory of Oncology in Southern China, Collaborative Innovation Centre for Cancer Medicine, and Department of Thoracic Surgery, Sun Yat-sen University Cancer Centre, Guangzhou 510060, China
| | - Calvin S H Ng
- Department of Surgery, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong SAR, China
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Qin T, Liu Y, An Y. Repair of inferior sternal cleft using a titanium plate in an infant with pentalogy of Cantrell. J Card Surg 2016; 31:700-702. [PMID: 27609343 DOI: 10.1111/jocs.12847] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- Tingjiang Qin
- Department of Cardiovascular and Thoracic Surgery; Children's Hospital of Chongqing Medical University; Chongqing China
- Key Laboratory of Pediatrics in Chongqing; Ministry of Education Key Laboratory of Child Development and Disorders; China International Science and Technology Cooperation Base of Child Development and Critical Disorders; Chongqing China
| | - Yingbei Liu
- Department of Cardiovascular and Thoracic Surgery; Children's Hospital of Chongqing Medical University; Chongqing China
- Key Laboratory of Pediatrics in Chongqing; Ministry of Education Key Laboratory of Child Development and Disorders; China International Science and Technology Cooperation Base of Child Development and Critical Disorders; Chongqing China
| | - Yong An
- Department of Cardiovascular and Thoracic Surgery; Children's Hospital of Chongqing Medical University; Chongqing China
- Key Laboratory of Pediatrics in Chongqing; Ministry of Education Key Laboratory of Child Development and Disorders; China International Science and Technology Cooperation Base of Child Development and Critical Disorders; Chongqing China
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De Palma A, Sollitto F, Loizzi D, Di Gennaro F, Scarascia D, Carlucci A, Giudice G, Armenio A, Ludovico R, Loizzi M. Chest wall stabilization and reconstruction: short and long-term results 5 years after the introduction of a new titanium plates system. J Thorac Dis 2016; 8:490-8. [PMID: 27076945 DOI: 10.21037/jtd.2016.02.64] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
BACKGROUND We report short and long-term results with the dedicated Synthes(®) titanium plates system, introduced 5 years ago, for chest wall stabilization and reconstruction. METHODS We retrospectively analyzed (January 2010 to December 2014) 27 consecutive patients (22 males, 5 females; range 16-83 years, median age 60 years), treated with this system: primary [3] and secondary [8] chest wall tumor; flail chest [5]; multiple ribs fractures [5]; sternal dehiscence-diastasis [3]; sternal fracture [1]; sternoclavicular joint dislocation [1]; Poland syndrome [1]. Short-term results were evaluated as: operating time, post-operative morbidity, mortality, hospital stay; long-term results as: survival, plates-related morbidity, spirometric values, chest pain [measured with Verbal Rating Scale (VRS) and SF12 standard V1 questionnaire]. RESULTS Each patient received from 1 to 10 (median 2) titanium plates/splints; median operating time was 150 min (range: 115-430 min). Post-operative course: 15 patients (55.6%) uneventful, 10 (37%) minor complications, 2 (7.4%) major complications; no post-operative mortality. Median post-operative hospital stay was 13 days (range: 5-129 days). At a median follow-up of 20 months (range: 1-59 months), 21 patients (78%) were alive, 6 (22%) died. Three patients presented long-term plates-related morbidity: plates rupture [2], pin plate dislodgment [1]; two required a second surgical look. One-year from surgery median spirometric values were: FVC 3.31 L (90%), FEV1 2.46 L (78%), DLCO 20.9 mL/mmHg/min (76%). On 21 alive patients, 7 (33.3%) reported no pain (VRS score 0), 10 (47.6%) mild (score 2), 4 (19.1%) moderate (score 4), no-one severe (score >4); 15 (71.5%) reported none or mild, 6 (28.5%) moderate pain influencing quality of life. CONCLUSIONS An optimal chest wall stabilization and reconstruction was achieved with the Synthes(®) titanium plates system, with minimal morbidity, no post-operative mortality, acceptable operating time and post-operative hospital stay. Long-term restoration of a normal respiratory function was achieved, with minimal plates-related morbidity and chest pain.
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Affiliation(s)
- Angela De Palma
- 1 Section of Thoracic Surgery, Department of Emergency and Organ Transplantation, University of Bari "Aldo Moro", Bari, Italy ; 2 Section of Thoracic Surgery, Department of Medical and Surgical Sciences, University of Foggia, Foggia, Italy ; 3 Section of Plastic Surgery and Burn Center, Department of Emergency and Organ Transplantation, University of Bari "Aldo Moro", Bari, Italy
| | - Francesco Sollitto
- 1 Section of Thoracic Surgery, Department of Emergency and Organ Transplantation, University of Bari "Aldo Moro", Bari, Italy ; 2 Section of Thoracic Surgery, Department of Medical and Surgical Sciences, University of Foggia, Foggia, Italy ; 3 Section of Plastic Surgery and Burn Center, Department of Emergency and Organ Transplantation, University of Bari "Aldo Moro", Bari, Italy
| | - Domenico Loizzi
- 1 Section of Thoracic Surgery, Department of Emergency and Organ Transplantation, University of Bari "Aldo Moro", Bari, Italy ; 2 Section of Thoracic Surgery, Department of Medical and Surgical Sciences, University of Foggia, Foggia, Italy ; 3 Section of Plastic Surgery and Burn Center, Department of Emergency and Organ Transplantation, University of Bari "Aldo Moro", Bari, Italy
| | - Francesco Di Gennaro
- 1 Section of Thoracic Surgery, Department of Emergency and Organ Transplantation, University of Bari "Aldo Moro", Bari, Italy ; 2 Section of Thoracic Surgery, Department of Medical and Surgical Sciences, University of Foggia, Foggia, Italy ; 3 Section of Plastic Surgery and Burn Center, Department of Emergency and Organ Transplantation, University of Bari "Aldo Moro", Bari, Italy
| | - Daniele Scarascia
- 1 Section of Thoracic Surgery, Department of Emergency and Organ Transplantation, University of Bari "Aldo Moro", Bari, Italy ; 2 Section of Thoracic Surgery, Department of Medical and Surgical Sciences, University of Foggia, Foggia, Italy ; 3 Section of Plastic Surgery and Burn Center, Department of Emergency and Organ Transplantation, University of Bari "Aldo Moro", Bari, Italy
| | - Annalisa Carlucci
- 1 Section of Thoracic Surgery, Department of Emergency and Organ Transplantation, University of Bari "Aldo Moro", Bari, Italy ; 2 Section of Thoracic Surgery, Department of Medical and Surgical Sciences, University of Foggia, Foggia, Italy ; 3 Section of Plastic Surgery and Burn Center, Department of Emergency and Organ Transplantation, University of Bari "Aldo Moro", Bari, Italy
| | - Giuseppe Giudice
- 1 Section of Thoracic Surgery, Department of Emergency and Organ Transplantation, University of Bari "Aldo Moro", Bari, Italy ; 2 Section of Thoracic Surgery, Department of Medical and Surgical Sciences, University of Foggia, Foggia, Italy ; 3 Section of Plastic Surgery and Burn Center, Department of Emergency and Organ Transplantation, University of Bari "Aldo Moro", Bari, Italy
| | - Andrea Armenio
- 1 Section of Thoracic Surgery, Department of Emergency and Organ Transplantation, University of Bari "Aldo Moro", Bari, Italy ; 2 Section of Thoracic Surgery, Department of Medical and Surgical Sciences, University of Foggia, Foggia, Italy ; 3 Section of Plastic Surgery and Burn Center, Department of Emergency and Organ Transplantation, University of Bari "Aldo Moro", Bari, Italy
| | - Rossana Ludovico
- 1 Section of Thoracic Surgery, Department of Emergency and Organ Transplantation, University of Bari "Aldo Moro", Bari, Italy ; 2 Section of Thoracic Surgery, Department of Medical and Surgical Sciences, University of Foggia, Foggia, Italy ; 3 Section of Plastic Surgery and Burn Center, Department of Emergency and Organ Transplantation, University of Bari "Aldo Moro", Bari, Italy
| | - Michele Loizzi
- 1 Section of Thoracic Surgery, Department of Emergency and Organ Transplantation, University of Bari "Aldo Moro", Bari, Italy ; 2 Section of Thoracic Surgery, Department of Medical and Surgical Sciences, University of Foggia, Foggia, Italy ; 3 Section of Plastic Surgery and Burn Center, Department of Emergency and Organ Transplantation, University of Bari "Aldo Moro", Bari, Italy
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Sawan TG, Nickerson TP, Thiels CA, Aho JM, Cross WW, Schiller HJ, Kim BD. Load Sharing, not Load Bearing Plates: Lessons Learned from Failure of Rib Fracture Stabilization. Am Surg 2016. [DOI: 10.1177/000313481608200109] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
| | | | | | | | | | - Henry J. Schiller
- Division of Trauma, Critical Care, and General Surgery Mayo Clinic Rochester, MN
| | - Brian D. Kim
- Division of Trauma, Critical Care, and General Surgery Mayo Clinic Rochester, MN
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36
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Yang H, Tantai J, Zhao H. Clinical experience with titanium mesh in reconstruction of massive chest wall defects following oncological resection. J Thorac Dis 2015; 7:1227-34. [PMID: 26380739 DOI: 10.3978/j.issn.2072-1439.2015.05.13] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2015] [Accepted: 05/06/2015] [Indexed: 11/14/2022]
Abstract
OBJECTIVES To present our experience of reconstructing wide defects with porously titanium mesh after radical resection of malignant chest wall tumors. METHODS A retrospective review of surgical reconstruction for large chest wall resections with titanium mesh was conducted from January 2009 to August 2014 in Shanghai Chest Hospital. RESULTS A total of 27 patients underwent major chest wall reconstructions with titanium mesh, following oncological resections. Chest wall sarcomas were the most frequent (63.0%). The mean tumor size was 72.4 (range, 36-140) cm(2). The average size of the applied porously titanium mesh was 140.9 (range, 80-225) cm(2). Mean postoperative length of stay was 7.1 (range, 4-14) days. There were no perioperative mortalities. Four (14.8%) patients experienced treatable complications. All had a resection of at least 3 ribs (median 3, mean 3.5 ribs). A total of 22 patients underwent ribs without sternal resections, and five patients underwent partial sternal resections with adjacent costal cartilage. Anterior chest wall resections were performed in 13 patients while lateral chest wall resections were performed in 9 patients. Three patients had extended resections beyond the chest wall in patients with primary chest wall malignancies, including two with wedge resections of lung and one with partial resection of pericardium. No patient was lost to follow-up. Mean follow-up was 30.7 months. Neither chest wall instability nor wound infection/necrosis was observed. Of these, 23 patients (85.2%) were alive at the last follow-up. Local recurrence was detected in three cases. The 5-year disease-free and overall survivals of primary chest tumors were 72.1% and 80.8%, respectively. CONCLUSIONS Our results showed that chest wall reconstruction utilizing synthetic titanium meshes following extensive resections of the chest wall malignant tumors allowed adequate resection size, with acceptable complications and survival benefits.
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Affiliation(s)
- Haitang Yang
- Department of Thoracic Surgery, Shanghai Chest Hospital, Shanghai Jiaotong University, Shanghai 200030, China
| | - Jicheng Tantai
- Department of Thoracic Surgery, Shanghai Chest Hospital, Shanghai Jiaotong University, Shanghai 200030, China
| | - Heng Zhao
- Department of Thoracic Surgery, Shanghai Chest Hospital, Shanghai Jiaotong University, Shanghai 200030, China
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37
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Bonne SL, Turnbull IR, Southard RE. Technique for repair of fractures and separations involving the cartilaginous portions of the anterior chest wall. Chest 2015; 147:e199-e204. [PMID: 26033132 DOI: 10.1378/chest.14-0757] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
Abstract
Internal fixation of the ribs has been shown in numerous studies to decrease complications following traumatic rib fractures. Anterior injuries to the chest wall causing cartilaginous fractures, although rare, can cause significant disability and can lead to a variety of complications and, therefore, pose a unique clinical problem. Here, we report the surgical technique used for four patients with internal fixation of injuries to the cartilaginous portions of the chest wall treated at our center. All patients had excellent clinical outcomes and reported improvement in symptoms, with no associated complications. Patients who have injuries to the anterior portions of the chest wall should be considered for internal fixation of the chest wall when the injuries are severe and can lead to clinical disability.
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Affiliation(s)
- Stephanie L Bonne
- Department of Surgery, Section of Acute and Critical Care Surgery, Washington University in St. Louis, St. Louis, MO.
| | - Isaiah R Turnbull
- Department of Surgery, Section of Acute and Critical Care Surgery, Washington University in St. Louis, St. Louis, MO
| | - Robert E Southard
- Department of Surgery, Section of Acute and Critical Care Surgery, Washington University in St. Louis, St. Louis, MO
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Czyz M, Addae-Boateng E, Boszczyk BM. Chest wall reconstruction after en bloc Pancoast tumour resection with the use of MatrixRib and SILC fixation systems: technical note. EUROPEAN SPINE JOURNAL : OFFICIAL PUBLICATION OF THE EUROPEAN SPINE SOCIETY, THE EUROPEAN SPINAL DEFORMITY SOCIETY, AND THE EUROPEAN SECTION OF THE CERVICAL SPINE RESEARCH SOCIETY 2015. [PMID: 26219916 DOI: 10.1007/s00586-015-4164-y] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
STUDY DESIGN Technical note. OBJECTIVE In cases in which partial resection of the rib cage is accomplished with vertebrectomy, reconstruction of the chest wall may be challenging. That is because of lack of the anchor point which normally would be a proximal end of a rib or transverse process. We report a straightforward technique for chest wall reconstruction with the novel use of two systems of fixation commonly applied in spinal practice. METHODS The operation of a squamous cell carcinoma (Pancoast tumour) of the right lung infiltrating T2, T3 and T4 vertebrae was performed though T4 lateral thoracotomy. Posterior instrumentation with transpedicular screws T1-3-5 on the left and T1-5 on the right side was followed with the right upper lobectomy and hemivertebrectomy. The laminae and facet joints of T2-T4 vertebrae were removed on the side of the tumour. An osteotomy was performed medial to the pedicle at the lateral aspect of the dural sac on the side of the tumour. Proximal parts of four adjacent ribs were removed allowing radical en bloc resection with tumour-free margins. The distal end of each of four rib plates used (MatrixRib Precontoured Plate system) was attached to the proximal end of the rib. The proximal end of the plate was then attached to the rod of posterior fixation construct with the use of a flexible polyethylene terephthalate (PeT) band of the SILC™ fixation system. The other end of the PeT band was then passed through the top-loading clamp subsequently attached to the rod of the posterior fixation. RESULTS The patient did not require additional procedures for chest wall reconstruction. On the 7-month follow-up, in chest CT he was found with satisfactory expansion of the remaining lung tissue with proper spinal alignment and anatomical shape of the rib cage. CONCLUSIONS The reported technique can be applied for chest wall reconstruction in cases of total or subtotal vertebrectomy accomplished with the resection extending towards rib cage. It appears to be straightforward, safe and effective allowing good cosmetic and functional outcome.
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Affiliation(s)
- Marcin Czyz
- The Centre for Spinal Studies and Surgery, Nottingham University Hospitals NHS Trust, D Floor, West Block, Queens Medical Centre, Derby Road, Nottingham, NG7 2UH, UK.
| | - Emmanuel Addae-Boateng
- The Department of Cardiothoracic Surgery, Nottingham University Hospitals NHS Trust, Nottingham, UK
| | - Bronek M Boszczyk
- The Centre for Spinal Studies and Surgery, Nottingham University Hospitals NHS Trust, D Floor, West Block, Queens Medical Centre, Derby Road, Nottingham, NG7 2UH, UK.
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Ng CSH. Recent and Future Developments in Chest Wall Reconstruction. Semin Thorac Cardiovasc Surg 2015; 27:234-9. [PMID: 26686454 DOI: 10.1053/j.semtcvs.2015.05.002] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/17/2015] [Indexed: 02/07/2023]
Abstract
Reconstruction following major chest wall resection can be challenging. Conventional methods of using mesh with or without incorporation of methyl methacrylate are slowly being replaced by chest wall reconstruction prosthetic systems that use titanium plates or bars. The most popular systems in use are the titanium STRATOS bars and MatrixRIB plates, which have different systems for securing to the chest wall. In general, these new approaches are user friendly, are more ergonomic, and may avoid certain complications associated with the more conventional methods of reconstruction. However, the successful implantation of these titanium prosthetic systems requires the operator to be familiar with the limitations and potential pitfalls of the process. Follow-up data are only just emerging on the risk factors for implant failure of these prosthetic systems, as well as certain device-specific complications, with fracture failure being increasingly recognized as a significant problem. In the future, emerging intraoperative real-time imaging and 3-dimensional printing technology, as well as development in biomaterials, will allow chest wall reconstruction to become increasingly personalized.
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Affiliation(s)
- Calvin S H Ng
- Department of Surgery, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong SAR, PR China.
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40
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Berthet JP, Gomez Caro A, Solovei L, Gilbert M, Bommart S, Gaudard P, Canaud L, Alric P, Marty-Ané CH. Titanium Implant Failure After Chest Wall Osteosynthesis. Ann Thorac Surg 2015; 99:1945-52. [DOI: 10.1016/j.athoracsur.2015.02.040] [Citation(s) in RCA: 40] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/19/2014] [Revised: 02/08/2015] [Accepted: 02/12/2015] [Indexed: 12/01/2022]
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41
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Kamel M, Port J, Altorki NK. Sternal Resections: New Materials for Reconstruction. CURRENT SURGERY REPORTS 2015. [DOI: 10.1007/s40137-015-0094-1] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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42
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Evaluation of respiratory functions in chest trauma patients treated with thoracic wall stabilization. EGYPTIAN JOURNAL OF CHEST DISEASES AND TUBERCULOSIS 2015. [DOI: 10.1016/j.ejcdt.2014.10.005] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
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Hamaji M, Kojima F, Koyasu S, Nobashi T, Tsuruyama T, Date H, Nakamura T. A rigid and bioabsorbable material for anterior chest wall reconstruction in a canine model. Interact Cardiovasc Thorac Surg 2014; 20:322-8. [PMID: 25505306 DOI: 10.1093/icvts/ivu416] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
OBJECTIVES The optimal material for anterior chest wall reconstruction following chest wall resection remains controversial. The aim of this experimental study was to evaluate short-term, morphological and histological outcomes of anterior chest wall reconstruction with a rigid and bioabsorbable material in a canine model. METHODS Twenty adult beagle dogs underwent anterior chest wall resection. In the experimental group (n = 10), the anterior chest wall was reconstructed with a rigid and bioabsorbable material composed of poly-L-lactide acid matrix (60 wt%) and uncalcined and unsintered hydroxyapatite particles (40 wt%), whereas in the control group it was (n = 10) reconstructed with dual polypropylene mesh sheets. Short-term complication rates were compared with a χ(2) test. Postoperative sternal deviations were evaluated with sternal alignment angles using computed tomography and multiplanar reconstruction and were compared with Mann-Whitney U-test immediately after reconstruction, and at 1, 3, 6, 9 and 12 months postoperatively. Histological findings of the regenerated chest wall tissue were obtained after staining with haematoxylin and eosin and Elastica van Gieson (EVG) and compared at 3, 6, 9 and 12 months. RESULTS There was not a significant difference in the short-term postoperative complication rate (P = 0.53) and the complication rate was 20% (wound infection, n = 1 and lethal mediastinitis, n = 1) in the control group and 10% (wound infection, n = 1) in the experimental group. The postoperative sternal deviation was significantly less remarkable at 1 month (123.3 ± 32.2° vs 159.4 ± 19.7°, P = 0.027), 3 months (109.8 ± 34.7° vs 150.9 ± 34.2°, P = 0.039) and 12 months (61 ± 15.6° vs 170.3 ± 6.6°, P = 0.046) in the experimental group than in the control group, whereas no significant difference was noted immediately after reconstruction (165.7 ± 6.4° vs 168.4 ± 9.1°, P = 0.50). Histological findings showed dense connective tissue in the regenerated chest wall in both groups and showed chondroblasts in the regenerated chest wall tissue at 3 and 6 months only in the experimental group. CONCLUSIONS Our results suggest that anterior chest wall reconstruction with a rigid and bioabsorbable material is feasible and may be a valuable alternative to reconstruction with a non-rigid and non-absorbable material.
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Affiliation(s)
- Masatsugu Hamaji
- Department of Bioartificial Organs, Graduate School of Medicine, Kyoto University, Kyoto, Japan Department of Thoracic Surgery, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Fumitsugu Kojima
- Department of Bioartificial Organs, Graduate School of Medicine, Kyoto University, Kyoto, Japan Department of Thoracic Surgery, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Sho Koyasu
- Department of Diagnostic Imaging and Nuclear Medicine, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Tomomi Nobashi
- Department of Diagnostic Imaging and Nuclear Medicine, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Tatsuaki Tsuruyama
- Center for Anatomical, Pathological and Forensic Medical Researches, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Hiroshi Date
- Department of Thoracic Surgery, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Tatsuo Nakamura
- Department of Bioartificial Organs, Graduate School of Medicine, Kyoto University, Kyoto, Japan
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Kaplan T, Gulbahar G, Gundogdu AG, Han S. An Unexpected Complication of Titanium Rib Clips. Ann Thorac Surg 2014; 98:2206-9. [DOI: 10.1016/j.athoracsur.2014.02.054] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/04/2013] [Revised: 01/02/2014] [Accepted: 02/04/2014] [Indexed: 10/24/2022]
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45
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Westphal FL, Lima LCD, Lima Netto JC, Seelig SDC, Lima KFD. Chest wall reconstruction with titanium plates after desmoid tumor resection. J Bras Pneumol 2014; 40:200-2. [PMID: 24831408 PMCID: PMC4083637 DOI: 10.1590/s1806-37132014000200017] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2013] [Accepted: 10/15/2013] [Indexed: 11/30/2022] Open
Affiliation(s)
- Fernando Luiz Westphal
- Getúlio Vargas University Hospital, School of Medicine, Federal University of Amazonas, Manaus, Brazil
| | - Luís Carlos de Lima
- Getúlio Vargas University Hospital, School of Medicine, Federal University of Amazonas, Manaus, Brazil
| | - José Corrêa Lima Netto
- Getúlio Vargas University Hospital, School of Medicine, Federal University of Amazonas, Manaus, Brazil
| | - Stephany da Cunha Seelig
- Getúlio Vargas University Hospital, School of Medicine, Federal University of Amazonas, Manaus, Brazil
| | - Katienne Frota de Lima
- Getúlio Vargas University Hospital, School of Medicine, Federal University of Amazonas, Manaus, Brazil
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Sarıtaş A, Güneren G, Sarıtaş PU, Kızılkaya SA, Ugış C. The Decrease of the Duration of Stay in the ICU with Rib Fixation in a Case of Multiple Rib Fracture. Turk J Anaesthesiol Reanim 2014; 42:277-9. [PMID: 27366436 DOI: 10.5152/tjar.2014.67044] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2013] [Accepted: 11/25/2013] [Indexed: 11/22/2022] Open
Abstract
Severe breathing problems arise in multiple rib fractures. As a result, many advantages of the surgical stabilization of the chest wall have been reported. Especially, shortening mechanical ventilation, along with a decrease in the duration of intensive care unit stay, is important for the prevention of possible infection complications. In this study, the dramatic improvement of the breathing pattern, as well as the reduction in ventilator duration after rib fixation time, of a 36-year-old patient with severe respiratory distress who had multiple rib fractures due to a road traffic accident was discussed. Due to this fact, it is concluded that patients could be discharged from the hospital earlier and uncomplicated as a result of fixation of the rib with the right indications.
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Affiliation(s)
- Aykut Sarıtaş
- Clinic of Anaesthesiology and Reanimation, Prof. Dr. A. İlhan Özdemir State Hospital, Giresun, Turkey
| | - Gökhan Güneren
- Clinic of Chest Surgery, Milas State Hospital, Muğla, Turkey
| | - Pelin Uzun Sarıtaş
- Clinic of Anaesthesiology and Reanimation, Prof. Dr. A. İlhan Özdemir State Hospital, Giresun, Turkey
| | | | - Cengiz Ugış
- Clinic of Anaesthesiology and Reanimation, Prof. Dr. A. İlhan Özdemir State Hospital, Giresun, Turkey
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Ng CSH, Ho AMH, Lau RWH, Wong RHL. Chest wall reconstruction with MatrixRib system: avoiding pitfalls. Interact Cardiovasc Thorac Surg 2013; 18:402-3. [PMID: 24336700 DOI: 10.1093/icvts/ivt515] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Reconstructions of the chest wall using commercially available artificial metallic rib systems are gaining in popularity. The MatrixRib system involves use of plates and screws to bridge any defect and provide support for the chest wall following resection. So far, there has been no publication focusing on describing the use of this new technology in a step-by-step approach. We describe our technique and discuss potential pitfalls and difficulties of using the system.
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Affiliation(s)
- Calvin S H Ng
- Department of Surgery, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong SAR, China
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Demondion P, Mercier O, Kolb F, Fadel E. Sternal replacement with a custom-made titanium plate after resection of a solitary breast cancer metastasis. Interact Cardiovasc Thorac Surg 2013; 18:145-7. [PMID: 24140815 DOI: 10.1093/icvts/ivt456] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
Abstract
Bone is the most common metastatic site of breast cancer (BC) and sternal metastasis usually occurs in an isolated setting. We performed sternal reconstruction using a new total titanium custom-made neosternum after subtotal sternectomy for an isolated BC metastasis. Postoperative care was uneventful during a 7-day in-hospital stay. After a 6-month follow-up, the patient denied any shortness of breath, chest pain or limitation on her daily activities. The chest was stable without any paradoxical motion. Chest X-ray did not show any material fracture, pleural effusion or lung abnormalities. As it entails lower postoperative risk than previously existing reconstructive materials, the new material used in our sternal reconstruction may extend the existing range of indications of sternectomy for cancer with curative intent.
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Affiliation(s)
- Pierre Demondion
- Department of Thoracic and Vascular Surgery and Heart-Lung Transplantation, Marie Lannelongue Hospital, Paris-Sud University, Le Plessis Robinson, France
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Hajj-Chahine J, Allain G, Tomasi J, Corbi P, Jayle C. Late postcardiotomy sternal dehiscence: a simple approach using Stratos® system. J Card Surg 2013; 28:632-4. [PMID: 23656221 DOI: 10.1111/jocs.12123] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
Management of late sternal dehiscence is challenging and time consuming. Although numerous techniques exist including rewiring and titanium plates screwing to stabilize the sternum, we describe an alternative technique by using four titanium clips and one connecting bar.
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Affiliation(s)
- Jamil Hajj-Chahine
- Department of Cardio-thoracic Surgery, University Hospital of Poitiers, Poitiers, France
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