Results of bony chest wall reconstruction with expanded polytetrafluoroethylene soft tissue patch

Expanded polytetrafluoroethylene mesh in chest-wall reconstruction: A 27-year experience

OBJECTIVE

The study objective was to evaluate the success of expanded polytetrafluoroethylene mesh in chest-wall reconstruction.

METHODS

We retrospectively reviewed patients who underwent expanded polytetrafluoroethylene (Gore-Tex) chest-wall reconstruction. The main outcome was a mesh-related event, defined as a mesh-related reoperation (eg, mesh infection requiring debridement with/without explant, tumor recurrence with explant) or structural dehiscence/mesh loosening with/without a hernia. Demographics and surgical outcomes were reported.

RESULTS

A total of 246 reconstructions met inclusion (1994-2021). Fifty-five reconstructions (22.4%) had mesh-related events within a median of 1.08 years (interquartile range, 0.08-4.53) postoperatively; those without had a stable chest for a median of 3.9 years (interquartile range, 1.59-8.23, P < .001). Forty-one meshes (16.6%) became infected, requiring reoperation. Eighty-eight percent (36/41) were completely explanted; 8.3% (3/36) required additional mesh placement. Predictors of mesh-related events were prior chest-wall radiation (odds ratio, 9.73, CI, 3.47-30.10, P < .001), higher body mass index (odds ratio, 1.08, CI, 1.01-1.16, P = .019), and larger defects (odds ratio, 1.48, CI, 1.02-2.17, P = .042). The risk of mesh-related events with obesity was higher with prior chest-wall radiation.

CONCLUSIONS

Most patients (78%) with an expanded polytetrafluoroethylene mesh had a stable reconstruction after a median of 4 years. Obesity, larger defects, and prior chest-wall radiation were associated with a higher risk of a mesh-related event mostly due to mesh infections. Seventeen percent of reconstructions had reoperation for mesh infection; 88% were completely explanted. Only 8% required replacement mesh, suggesting that experienced surgeons can safely manage them without replacement. Future studies should compare various meshes for high-risk patients to help guide the optimal mesh selection.

Primary sternal tumour resection and reconstruction with LARS mesh-bone cement sandwich by 3D-printing: Case reports

Background: There are many reconstruction methods after sternal tumor resection, but the method that LARS mesh combines with bone-cement has not been reported. Case report: A 54-year-old female patient and a 55-year-old male patient admitted to our department all presented with sternum masses, but neither presented with respiratory disorders. In women with limited manubrium sternum lesions, we resected the manubrium sternum completely. In men with sternal lesions, we removed part of the sternum and part of the sternocostal joint. The patients recovered well after surgery, and there were no respiratory complications and no tumor recurrence during the 1-year follow-up respectively. Conclusion: We report two cases of sternal defect repair using LARS mesh combined with bone cement. This method is safe and stable, and can achieve satisfactory results.

Chest wall reconstruction in benign and malignant tumors with non-rigid materials: An overview

Several materials and techniques have been described for the procedure of chest wall reconstruction: the choice of using a technique or a material over another relies mainly on the surgeon's experience as well as thoracic defect localization and dimension, local availability of materials, and costs. From a technical point of view, autologous and alloplastic reconstruction are available, and, in both cases, rigid and non-rigid prostheses are found. Each material has its peculiarities, with advantages and disadvantages; thus, it is mandatory to be confident when planning the intervention to foresee possible complications and minimize them. We have reviewed the literature on chest wall reconstruction in chest wall tumors (both malignant and non malignant) with non-rigid prosthetic materials, focusing on safety outcomes.

Defect Coverage after Forequarter Amputation—A Systematic Review Assessing Different Surgical Approaches

Autologous fillet flaps are a common reconstructive option for large defects after forequarter amputation (FQA) due to advanced local malignancy or trauma. The inclusion of osseous structures into these has several advantages. This article therefore systematically reviews reconstructive options after FQA, using osteomusculocutaneous fillet flaps, with emphasis on personalized surgical technique and outcome. Additionally, we report on a case with an alternative surgical technique, which included targeted muscle reinnervation (TMR) of the flap. Our literature search was conducted in the PubMed and Cochrane databases. Studies that were identified were thoroughly scrutinized with regard to relevance, resulting in the inclusion of four studies (10 cases). FQA was predominantly a consequence of local malignancy. For vascular supply, the brachial artery was predominantly anastomosed to the subclavian artery and the brachial or cephalic vein to the subclavian or external jugular vein. Furthermore, we report on a case of a large osteosarcoma of the humerus. Extended FQA required the use of the forearm for defect coverage and shoulder contour reconstruction. Moreover, we performed TMR. Follow-up showed a satisfactory result and no phantom limb pain. In case of the need for free flap reconstruction after FQA, this review demonstrates the safety and advantage of osteomusculocutaneous fillet flaps. If the inclusion of the elbow joint into the flap is not possible, we recommend the use of the forearm, as described. Additionally, we advocate for the additional implementation of TMR, as it can be performed quickly and is likely to reduce phantom limb and neuroma pain.

A South American Experience With Postoperative Complications Following Chest Wall Reconstruction for Neoplasms

BACKGROUND

This study aims to report postoperative complications of chest wall reconstructions due to resections of primary or secondary neoplasms in a South American cancer institution and their association with prosthesis reconstruction.

MATERIALS AND METHODS

We retrospectively reviewed clinical records of patients with primary or secondary chest wall neoplasms who underwent resection and reconstruction between November 2008 and October 2018 at the Instituto Nacional de Cancerología, Bogota, Colombia.

RESULTS

A total of 77 patients were analyzed, 50 were women (64.9%), and the median age was 45.8 years. There were 22(28.6%) sternal resections and 55(71.4%) costal resections. Prosthetic material was used in 14(18.2%) sternal and 37(48.1%) costal reconstructions. There were 26(33.7%) early postoperative complications and 16(20.8%) reinterventions. Infections were observed in 12(15.6%) patients and 4(5.2%) patients developed respiratory complications. 33.3% of all the early infections were presented in patients with methyl methacrylate (MMA) reconstructions and the same percentage in those with titanium plates. There were six (7.8%) late complications and five were related to prosthetic material extrusion, all required prosthetic material removal. The mean overall survival was 77,3 months (SD = 8 months), and 1-year and 5-year overall survival was 85% and 61%, respectively.

CONCLUSIONS

Infections were the more frequent postoperative complications in chest wall reconstructions. The use of either MMA or titanium plates was not related to early postoperative complications, although MMA reconstructions developed higher late complications and required prosthetic material removal.

[Chest Wall Reconstruction Using Polypropylene Mesh: a Single-Center 8-Year Analysis]

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.

[Research Status of the Skeletalre Construction of Chest Wall]

肿瘤切除或外伤等多种因素均有可能导致胸壁缺损，骨性胸壁缺损的重建依旧是胸外科手术的重点和难点。随着材料学的不断进展，越来越多的新材料运用于骨性胸壁重建，一定程度上推动了胸壁外科的发展。但是，目前临床上常用的重建材料尚无一种能完全满足临床工作的需要。随着计算机技术的高速发展，3D打印技术也逐步运用于临床，个性化治疗理念逐步深入人心。个性化治疗配合新材料的使用极有希望克服现有材料的不足，使胸壁外科达到一个新高度。因此，本文对缺损胸壁重建的发展和现状做一综述，并对其发展方向做一积极展望。

Outcomes of chest wall resections in pediatric sarcoma patients

PURPOSE

Chest wall tumors in pediatric patients are rare. This study evaluates outcomes in pediatric patients who have undergone chest wall resections secondary to sarcomas.

METHODS

A retrospective review was performed for patients <19years old who underwent chest wall resections for sarcoma 1999-2014 at the University of Texas MD Anderson Cancer Center.

RESULTS

Of 44 patients, Ewing's sarcoma (n=18) and osteosarcoma (n=16) were most common. Other sarcomas included synovial sarcoma, chondrosarcoma, and rhabdomyosarcoma. Gore-Tex® or a Marlex™ mesh and methyl methacrylate sandwich was used in 22 patients, and 9 children did not require reconstruction. Twenty-four (54.5%) patients had normal activity, 3 (6.8%) had occasional discomfort, 2 (4.5%) had pain impairing function, 7 (15.9%) required medication or physical therapy for impairment, and 8 (18.2%) needed additional surgery. Five children (11.4%) developed scoliosis, and all of these patients had posterior rib tumors. Median overall survival for the entire cohort was 41.9±11.82months. Histology (p=0.003), location of tumor on the ribs (p=0.007), and surgical margins (p=0.011) were significantly associated with overall survival. Tumors on the middle and posterior (p=0.003) portions of the ribs had a lower chance of death.

CONCLUSION

Scoliosis is more common in posterior rib resections. Histology, location of the tumor, and surgical margins impact survival, but, type of reconstruction does not.

LEVEL OF EVIDENCE

III.

TYPE OF STUDY

Treatment Study.