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Ducrot C, Piffoux M, Rabattu PY, Pourquet A, Peyrot Q, Robert Y, Chotel F, Hameury F. Reconstruction with antibiotic loaded single-side gore-tex "Tartine" methyl-methacrylate cementoplasty for pediatric chest wall reconstruction: A 10-case series. Orthop Traumatol Surg Res 2024:103895. [PMID: 38657749 DOI: 10.1016/j.otsr.2024.103895] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/09/2023] [Revised: 04/08/2024] [Accepted: 04/18/2024] [Indexed: 04/26/2024]
Abstract
INTRODUCTION Chest wall reconstruction in children after large resection of tumors may be performed with rigid or soft materials. Cementoplasty is commonly used with the "Sandwich" method i.e. gore-tex meshes surrounding both faces of the cement. HYPOTHESIS Is antibiotic loaded single-side gore-tex "Tartine" methyl-methacrylate cementoplasty an interesting alternative to the double-side "sandwich" method for chest wall reconstruction? MATERIAL AND METHODS Consecutive patients who were treated from 2011 to 2023 in our hospital were included. RESULTS Among the ten children treated with a median 5.6 years follow-up, there were no surgical complications related to the reconstruction, loss of function, infections, post operative complications (versus 22.7% in meta-analysis encompassing the 50 rigid reconstructions reported worldwide) nor scoliosis (versus 25%). Three patients have an asymmetric chest wall appearance. DISCUSSION "Tartine" cementoplasty is a simple, low-cost technique for pediatric chest wall reconstruction. It is well tolerated and checks key demands for chest wall reconstructions. LEVEL OF EVIDENCE IV; retrospective case series.
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Affiliation(s)
- Coline Ducrot
- Department of Pediatric Orthopedic Surgery, Hôpital Femme Mère Enfant, 32, avenue du Doyen-Jean-Lépine, 69677 Lyon cedex, France; Team Cell Death and Pediatric Cancer, Cancer Initiation and Tumor Cell Identity Department, Inserm 1052, CNRS5286, Cancer Research Center of Lyon, 69008 Lyon, France.
| | - Max Piffoux
- Medical Oncology - oncologie médicale, centre Léon-Bérard, Lyon, France; Medical Oncology, hospices civils de Lyon, Lyon, France; Laboratoire matière et systèmes complexes (MSC), université de Paris, CNRS UMR7057, 45, rue des Saints-Pères, 75006 Paris, France
| | - Pierre Yves Rabattu
- Department of Pediatric Visceral Surgery, CHU of Grenoble Alpes, Hôpital couple enfant, quai Yermoloff, 38700 La Tronche, France
| | - Anne Pourquet
- Department of Pediatric Orthopedic Surgery, Hôpital Femme Mère Enfant, 32, avenue du Doyen-Jean-Lépine, 69677 Lyon cedex, France
| | - Quoc Peyrot
- Department of Pediatric Thoracic Surgery, Hôpital Femme Mère Enfant, 32, avenue du Doyen-Jean-Lépine, 69677 Lyon cedex, France
| | - Yohann Robert
- Department of Pediatric Visceral Surgery, CHU of Grenoble Alpes, Hôpital couple enfant, quai Yermoloff, 38700 La Tronche, France
| | - Franck Chotel
- Department of Pediatric Orthopedic Surgery, Hôpital Femme Mère Enfant, 32, avenue du Doyen-Jean-Lépine, 69677 Lyon cedex, France
| | - Fréderic Hameury
- Department of Pediatric Thoracic Surgery, Hôpital Femme Mère Enfant, 32, avenue du Doyen-Jean-Lépine, 69677 Lyon cedex, France
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Kavaklı K, Işık H, Şengül İnan M, Sapmaz E, Yeniköy M, Ünsal U, Kılınç D, Çaylak H. Should wide chest wall resections and reconstruction intimidate thoracic surgeons? TURK GOGUS KALP DAMAR CERRAHISI DERGISI 2024; 32:195-201. [PMID: 38933314 PMCID: PMC11197412 DOI: 10.5606/tgkdc.dergisi.2024.25804] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/01/2023] [Accepted: 01/11/2024] [Indexed: 06/28/2024]
Abstract
Background This study aimed to compare patients in whom wide chest wall resection and reconstruction or primary closure was performed. Methods A total of 63 patients who underwent chest wall resection and reconstruction between January 2018 and December 2022 were included in the retrospective study. The patients were divided into two groups: the first group, which included 31 patients (14 males, 17 females; mean age: 44.6±16.4 years; range, 16 to 71 years) who were closed primarily, and the second group, constituting 32 patients (25 males, 7 females; mean age: 54.6±17.2 years; range, 9 to 80 years) who underwent reconstruction with plates and meshes. Results There was no significant difference between the two groups in terms of smoking and diabetes. Primary chest wall or metastatic tumor was determined in 33 patients; benign tumor and trauma were determined in 30 patients. The difference between the two groups in mean defect diameter (p=0.009), mean number of plates used (p<0.001), and mean hospital stay (p<0.001) was statistically significant. However, there was no significant difference in terms of complications (p=0.426). Conclusion Wide chest wall resection and reconstruction is a safe and feasible surgical procedure when compared with primary closure.
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Affiliation(s)
- Kuthan Kavaklı
- Department of Thoracic Surgery, Gülhane Training and Research Hospital, Ankara, Türkiye
| | - Hakan Işık
- Department of Thoracic Surgery, Gülhane Training and Research Hospital, Ankara, Türkiye
| | - Merve Şengül İnan
- Department of Thoracic Surgery, Gülhane Training and Research Hospital, Ankara, Türkiye
| | - Ersin Sapmaz
- Department of Thoracic Surgery, Gülhane Training and Research Hospital, Ankara, Türkiye
| | - Musab Yeniköy
- Department of Thoracic Surgery, Gülhane Training and Research Hospital, Ankara, Türkiye
| | - Ufuk Ünsal
- Department of Thoracic Surgery, Gülhane Training and Research Hospital, Ankara, Türkiye
| | - Denizhan Kılınç
- Department of Thoracic Surgery, Gülhane Training and Research Hospital, Ankara, Türkiye
| | - Hasan Çaylak
- Department of Thoracic Surgery, Gülhane Training and Research Hospital, Ankara, Türkiye
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Wong THY, Siu ICH, Lo KKN, Tsang EYH, Wan IYP, Lau RWH, Chiu TW, Ng CSH. Ten-Year Experience of Chest Wall Reconstruction: Retrospective Review of a Titanium Plate MatrixRIB™ System. Front Surg 2022; 9:947193. [PMID: 35865033 PMCID: PMC9294311 DOI: 10.3389/fsurg.2022.947193] [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: 05/18/2022] [Accepted: 06/07/2022] [Indexed: 11/13/2022] Open
Abstract
Chest wall tumor resection can result in a large defect that can pose a challenge in reconstruction in restoring chest wall contour, maintaining respiratory mechanics, and improving cosmesis. Titanium plates were first introduced for treating a traumatic flail chest, which yielded promising results in restoring chest wall stability. Subsequently, the applications of titanium plates in chest wall reconstruction surgery were demonstrated in case reports and series. Our center has adopted this technique for a decade, and patients are actively followed up after operation. Here, we retrospectively analyze our 10-year experience of using titanium plates and other reconstruction approaches for chest wall reconstruction, in terms of clinical outcomes, complications, and reasons for reoperation to determine long-term safety and efficacy. Thirty-eight patients who underwent chest wall resection and reconstruction surgery were identified. Of these, 11 had titanium plate insertion, 11 had patch repair or flap reconstruction, and the remaining 16 had primary closure of defects. Chest wall reconstruction using titanium plate(s) and patch repair (with or without flap reconstruction) was associated with larger chest wall defects and more sternal resections than primary closure. Subgroup analysis also showed that reconstruction by the titanium plate technique was associated with larger chest wall defects than patch repair or flap reconstruction [286.80 cm2 vs. 140.91 cm2 (p = 0.083)]. There was no 30-day hospital mortality. Post-operative arrhythmia was more commonly seen following chest wall reconstruction compared with primary closure (p = 0.041). Furthermore, more wound infections were detected following the use of titanium plate reconstruction compared with the patch repair (with or without flap reconstruction) approach (p = 0.027). In conclusion, the titanium plate system is a safe, effective, and robust approach for chest wall reconstruction surgery, especially in tackling larger defect sizes.
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Affiliation(s)
- Teddy H. Y. Wong
- Division of Cardiothoracic Surgery, Department of Surgery, The Chinese University of Hong Kong, Prince of Wales Hospital, Hong Kong SAR, China
| | - Ivan C. H. Siu
- Division of Cardiothoracic Surgery, Department of Surgery, The Chinese University of Hong Kong, Prince of Wales Hospital, Hong Kong SAR, China
| | - Kareem K. N. Lo
- Division of Cardiothoracic Surgery, Department of Surgery, The Chinese University of Hong Kong, Prince of Wales Hospital, Hong Kong SAR, China
| | - Ethan Y. H. Tsang
- Division of Cardiothoracic Surgery, Department of Surgery, The Chinese University of Hong Kong, Prince of Wales Hospital, Hong Kong SAR, China
| | - Innes Y. P. Wan
- Division of Cardiothoracic Surgery, Department of Surgery, The Chinese University of Hong Kong, Prince of Wales Hospital, Hong Kong SAR, China
| | - Rainbow W. H. Lau
- Division of Cardiothoracic Surgery, Department of Surgery, The Chinese University of Hong Kong, Prince of Wales Hospital, Hong Kong SAR, China
| | - T. W. Chiu
- Division of Plastic and Reconstructive Surgery, Department of Surgery, The Chinese University of Hong Kong, Prince of Wales Hospital, Hong Kong SAR, China
| | - Calvin S. H. Ng
- Division of Cardiothoracic Surgery, Department of Surgery, The Chinese University of Hong Kong, Prince of Wales Hospital, Hong Kong SAR, China
- Correspondence: Calvin S. H. Ng
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Fernandez RAS, Lau RWH, Yu PSY, Siu ICH, Chan JWY, Ng CSH. Use of custom made 3-dimensional printed surgical guide for manubrio-sternal resection of solitary breast cancer metastasis: case report. AME Case Rep 2020; 4:12. [PMID: 32420535 DOI: 10.21037/acr.2020.03.08] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2020] [Accepted: 03/29/2020] [Indexed: 11/06/2022]
Abstract
A 44-year-old lady with solitary 4.4-cm metastasis to the manubrium from a previously resected invasive ductal carcinoma of the left breast underwent manubrio-sternal resection. We describe our unique approach of using 3-dimensional (3D)-computed tomography (CT) image segmentation planning for reconstructing desirable resection boundaries, design of ideal superficial and deep surgical resection guides, and followed by 3D printing of guides using autoclavable thermoplastic for use during surgery. The surgical guides over the ribs and sternum rapidly and accurately define resection lines intraoperatively, achieve good surgical margins, and could reduce resection and reconstruction related morbidity for performing complex surgical resection of the chest wall. The patient was discharged 2 weeks postoperatively and remained free from local recurrence on CT scan 1-year after resection.
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Affiliation(s)
- Rafael A S Fernandez
- Division of Cardiothoracic Surgery, Department of Surgery, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong, China
| | - Rainbow W H Lau
- Division of Cardiothoracic Surgery, Department of Surgery, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong, China
| | - Peter S Y Yu
- Division of Cardiothoracic Surgery, Department of Surgery, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong, China
| | - Ivan C H Siu
- Division of Cardiothoracic Surgery, Department of Surgery, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong, China
| | - Joyce W Y Chan
- Division of Cardiothoracic Surgery, Department of Surgery, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong, China
| | - Calvin S H Ng
- Division of Cardiothoracic Surgery, Department of Surgery, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong, China
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Ahmad SB, Hoellwarth J, Christie N, Mcgough R. Radical resection of a giant rib osteosarcoma with complex chest wall reconstruction. Int J Surg Case Rep 2019; 62:17-20. [PMID: 31415940 PMCID: PMC6702432 DOI: 10.1016/j.ijscr.2019.07.080] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2019] [Revised: 07/09/2019] [Accepted: 07/29/2019] [Indexed: 12/30/2022] Open
Abstract
A 61-year-old male with a 20 cm primary osteosarcoma of the rib underwent a radical en bloc chest wall resection. Chest wall reconstruction was performed using a poly methyl methacrylate (“bone cement”) and polypropylene mesh “sandwich”. Functional, cosmetic, and oncologic outcomes at 6 months are excellent. Polypropylene mesh and “bone cement” represent a safe, easy, and affordable approach to reconstructing the rib cage even in cases of large defects.
Introduction Primary rib osteosarcoma is a rare chest wall tumor with variable presentation. Large tumors greater than 10 cm are even rarer and present a challenge for surgical management. Presentation of case A 61-year-old male with a giant osteosarcoma of the left 2nd rib underwent multidisciplinary management including induction therapy with doxorubicin and cisplatin, followed by en bloc resection with left ribs 1–5, spinous processes of ribs 2–5, small volume lung resection, and chest wall reconstruction with polypropylene mesh and poly methyl methacrylate (PMMA or bone cement). There were no perioperative complications. At 6 months follow-up, the patient remains disease-free. Functional and cosmetic outcome are excellent. Discussion This 20 cm mass and resection of ribs 1–5 with resulting 25 cm chest wall defect is the largest primary rib osteosarcoma reported in literature. An R0 resection and chest wall reconstruction using polypropylene mesh and bone cement was feasible and safe. Conclusion Giant chest wall defects involving multi-rib resection can be effectively reconstructed with commonly available and inexpensive polypropylene mesh and PMMA to achieve good cosmetic and functional outcomes.
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Affiliation(s)
- Sarwat B Ahmad
- Division of Surgical Oncology, Department of Surgery, University of Pittsburgh School of Medicine, 5230 Centre Ave, Pittsburgh, PA 15232, USA.
| | - Jason Hoellwarth
- Department of Orthopedic Surgery, University of Pittsburgh School of Medicine, 5230 Centre Ave, Pittsburgh, PA 15232, USA
| | - Neil Christie
- Division of Thoracic Surgery, University of Pittsburgh School of Medicine, 5230 Centre Ave, Pittsburgh, PA 15232, USA
| | - Richard Mcgough
- Department of Orthopedic Surgery, University of Pittsburgh School of Medicine, 5230 Centre Ave, Pittsburgh, PA 15232, USA
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Zhou XT, Zhang DS, Yang Y, Zhang GL, Xie ZX, Chen MH, Liang Z. Analysis of the advantages of 3D printing in the surgical treatment of multiple rib fractures: 5 cases report. J Cardiothorac Surg 2019; 14:105. [PMID: 31186011 PMCID: PMC6560852 DOI: 10.1186/s13019-019-0930-y] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2019] [Accepted: 06/03/2019] [Indexed: 11/29/2022] Open
Abstract
Background Rib fractures account for a fairly high proportion of chest injuries, ranging from 55 to 80%. The most common mechanisms of injury include: traffic accident, extrusion and falls from significant heights. Besides, the surgical treatment of multiple rib fractures has been accepted by more and more medical professionals. We reported 5 clinical cases of patients with multiple rib fractures undergoing open reduction and internal fixation using 3D printing technology. Case presentation Retrospective analysis of 5 clinical cases of multiple rib fractures from January 2017 to August 2018 in our hospital. A preoperative CT thin slice scan was used to reconstruct the 3D model according to the scanning results, and 3D printing technology was adopted to prepare the rib model. Preoperative reconstruction of the rib’s normal shape and lock plate for the shaped ribs was created according to reconstructed model. For multiple fractures especially patients with severely deformed rib shape, it is suggested to intraoperative shape directly to the metal bone plate fixed on the ribs on both ends of the fracture line, in order to establish a basic support frame. The other various fracture section can be fixed on the lock plate respectively. Postoperative chest radiographs of the 5 patients showed that the internal fixations were in good and natural shape. The thoracic contour was well formed and symmetrically with the contralateral side. Conclusion Making the rib model and the pre-shaped titanium alloy rib locking plate using 3D printing technology, provided a more minimally invasive and precisely individualized treatment for some rib fracture operations.
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Affiliation(s)
- Xue-Tao Zhou
- Department of Cardiothoracic Surgery, Shijiazhuang Third Hospital, No.15 Tiyu South Street, Chang'an District, Shijiazhuang, 050000, Hebei Province, China
| | - Dong-Sheng Zhang
- Department of Cardiothoracic Surgery, Shijiazhuang Third Hospital, No.15 Tiyu South Street, Chang'an District, Shijiazhuang, 050000, Hebei Province, China.
| | - Yang Yang
- Department of Cardiothoracic Surgery, Shijiazhuang Third Hospital, No.15 Tiyu South Street, Chang'an District, Shijiazhuang, 050000, Hebei Province, China
| | - Guo-Liang Zhang
- Department of Cardiothoracic Surgery, Shijiazhuang Third Hospital, No.15 Tiyu South Street, Chang'an District, Shijiazhuang, 050000, Hebei Province, China
| | - Ze-Xin Xie
- Department of Cardiothoracic Surgery, Shijiazhuang Third Hospital, No.15 Tiyu South Street, Chang'an District, Shijiazhuang, 050000, Hebei Province, China
| | - Meng-Hui Chen
- Department of Cardiothoracic Surgery, Shijiazhuang Third Hospital, No.15 Tiyu South Street, Chang'an District, Shijiazhuang, 050000, Hebei Province, China
| | - Zheng Liang
- Department of Cardiothoracic Surgery, Shijiazhuang Third Hospital, No.15 Tiyu South Street, Chang'an District, Shijiazhuang, 050000, Hebei Province, China
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Kwok JKS, Lau RWH, Zhao ZR, Yu PSY, Ho JYK, Chow SCY, Wan IYP, Ng CSH. Multi-dimensional printing in thoracic surgery: current and future applications. J Thorac Dis 2018; 10:S756-S763. [PMID: 29732197 DOI: 10.21037/jtd.2018.02.91] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Abstract
Three-dimensional (3D) printing has been gaining much attention in the medical field in recent years. At present, 3D printing most commonly contributes in pre-operative surgical planning of complicated surgery. It is also utilized for producing personalized prosthesis, well demonstrated by the customized rib cage, vertebral body models and customized airway splints. With on-going research and development, it will likely play an increasingly important role across the surgical fields. This article reviews current application of 3D printing in thoracic surgery and also provides a brief overview on the extended and updated use of 3D printing in bioprinting and 4D printing.
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Affiliation(s)
- Jackson K S Kwok
- Division of Cardiothoracic Surgery, Department of Surgery, The Chinese University of Hong Kong, Prince of Wales Hospital, Hong Kong, China
| | - Rainbow W H Lau
- Division of Cardiothoracic Surgery, Department of Surgery, The Chinese University of Hong Kong, Prince of Wales Hospital, Hong Kong, China
| | - Ze-Rui Zhao
- Division of Cardiothoracic Surgery, Department of Surgery, The Chinese University of Hong Kong, Prince of Wales Hospital, Hong Kong, China
| | - Peter S Y Yu
- Division of Cardiothoracic Surgery, Department of Surgery, The Chinese University of Hong Kong, Prince of Wales Hospital, Hong Kong, China
| | - Jacky Y K Ho
- Division of Cardiothoracic Surgery, Department of Surgery, The Chinese University of Hong Kong, Prince of Wales Hospital, Hong Kong, China
| | - Simon C Y Chow
- Division of Cardiothoracic Surgery, Department of Surgery, The Chinese University of Hong Kong, Prince of Wales Hospital, Hong Kong, China
| | - Innes Y P Wan
- Division of Cardiothoracic Surgery, Department of Surgery, The Chinese University of Hong Kong, Prince of Wales Hospital, Hong Kong, China
| | - Calvin S H Ng
- Division of Cardiothoracic Surgery, Department of Surgery, The Chinese University of Hong Kong, Prince of Wales Hospital, Hong Kong, China
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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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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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11
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Ng CS, Wong RH, Kwok MW, Yim AP. Delayed fracture of MatrixRIB precontoured plate system. Interact Cardiovasc Thorac Surg 2014; 19:512-4. [DOI: 10.1093/icvts/ivu175] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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