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Glueck OM, Ehrl D, Hatz RA, Fertmann JM. Mind the gap! Interdisciplinary approach to anterior chest wall reconstruction after total sternectomy. J Cardiothorac Surg 2024; 19:269. [PMID: 38689350 PMCID: PMC11059752 DOI: 10.1186/s13019-024-02743-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2023] [Accepted: 03/29/2024] [Indexed: 05/02/2024] Open
Abstract
BACKGROUND There are various reconstructive methods after total sternectomy. Reproducibility is scarce due to overall small patient numbers. Therefore we present a standardized, interdisciplinary approach for thoracic and plastic surgery. METHODS Four patients underwent interdisciplinary chest wall reconstruction with STRATOS® titanium bars and myocutaneous vastus lateralis muscle free flap in our center. RESULTS All patients reported chest wall stability after reconstruction. They reported good quality of life, no dyspnea, prolonged pain or impairment in lung function from rigid reconstruction. FEV1/FVC was overall better after surgery. Secondary wound healing was not impaired and there was no implant defect in follow up. CONCLUSIONS We recommend an interdisciplinary surgical approach in chest wall reconstruction after total sternectomy. The combination of rigid reconstruction with titanium bars and a myocutaneous vastus lateralis muscle free flap renders excellent results in patient satisfaction and is objectifiable via spirometry.
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Affiliation(s)
- Olaf Michael Glueck
- Division of Thoracic Surgery, LMU University Hospital, LMU Munich, Marchioninistraße 15, 81377, Munich, Germany.
| | - Denis Ehrl
- Division of Hand, Plastic and Aesthetic Surgery, LMU University Hospital, LMU Munich, Munich, Germany
| | - Rudolf A Hatz
- Division of Thoracic Surgery, LMU University Hospital, LMU Munich, Marchioninistraße 15, 81377, Munich, Germany
| | - Jan M Fertmann
- Division of Thoracic Surgery, LMU University Hospital, LMU Munich, Marchioninistraße 15, 81377, Munich, Germany
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2
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Gebremariyam ZT, Woldemariam ST, Beyene TD, Baharu LM. Reconstruction of massive chest wall defect after malignant chest wall mass excision in resource limited setting, a case report. Int J Surg Case Rep 2024; 117:109496. [PMID: 38503161 PMCID: PMC10963599 DOI: 10.1016/j.ijscr.2024.109496] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2024] [Revised: 03/05/2024] [Accepted: 03/07/2024] [Indexed: 03/21/2024] Open
Abstract
INTRODUCTION AND IMPORTANCE Chest wall tumors, rare but impactful, constitute less than 2 % of the population and 5 % of thoracic neoplasms. Wide-margin resection is vital, often causing substantial defects necessitating reconstruction. However, in resource-limited settings like sub-Saharan Africa, access to reconstruction materials is limited. We present a successful case of managing a massive chest wall defect using flexible wire and polypropylene mesh in such a context. CASE PRESENTATION A 40-year-old male presented with a gradually enlarging anterolateral chest wall mass, diagnosed as low-grade synovial sarcoma. Imaging revealed involvement of the 6th to 11th ribs with compression of the diaphragm and liver. A multidisciplinary team planned wide-margin excision, chest wall reconstruction, and adjuvant chemoradiation. Using a sternal wire bridge and polypropylene mesh, the 25 cm by 15 cm defect was reconstructed, covered with a latissimus dorsi flap. The patient recovered well postoperatively, highlighting the feasibility of innovative approaches in resource-limited settings. CLINICAL DISCUSSION Defects larger than 5 cm or involving over 4 ribs require reconstruction to prevent lung herniation and respiratory issues, especially for anteriorolateral defects. Our case featured a 25 by 15 cm anteriorolateral chest wall defect, necessitating rigid reconstruction. Due to resource constraints, we utilized flexible wires and polypropylene mesh, offering a cost-effective solution for managing massive chest wall defects. CONCLUSION This case underscores the challenges faced in managing chest wall tumors in resource-constrained regions and emphasizes the importance of innovative solutions for achieving successful outcomes in chest wall reconstruction.
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McCranie AS, Christodoulou N, Wolfe B, Malgor RD, Mathes DW, Winocour J, Yu JW, Kalia N, Kaoutzanis C. The use of flaps for management of deep sternal wound complications: A systematic review and meta-analysis. J Plast Reconstr Aesthet Surg 2024; 91:302-311. [PMID: 38442510 DOI: 10.1016/j.bjps.2024.02.041] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2023] [Accepted: 02/04/2024] [Indexed: 03/07/2024]
Abstract
BACKGROUND Many options are available for reconstruction after deep sternal wound infections. However, these options have not been critically appraised. The aim of this systematic review and meta-analysis was to assess the existing evidence on sternal rewiring versus flap reconstruction and pectoralis major muscle flaps (PMFs) versus greater omental flaps (GOFs). METHODS A systematic review and meta-analysis was performed. CENTRAL, MEDLINE and EMBASE were searched. Outcomes of interest included mortality, treatment failure and length of hospital stay (LOS). RESULTS Fourteen studies were included. Nine studies compared flaps to rewiring, reporting on 618 patients. Patients treated with flaps had significantly lower mortality compared with patient treated with rewiring (Risk ratio [RR] 0.42, 95% confidence interval [CI]: 0.23-0.77, P < 0.01). Flap patients had significantly lower treatment failure compared with those who were treated with rewiring (RR 0.22, 95% CI: 0.14-0.37, P < 0.01). No statistically significant differences were observed in LOS between patients treated with flaps compared those treated with rewiring (standard mean difference -0.84, 95% CI: -1.91 to 0.24, P = 0.13). Five studies compared PMF with GOF, reporting on 599 patients. No statistically significant differences were found in mortality (RR 0.63, 95% CI: 0.24-1.68, P = 0.36), LOS (standard mean difference -14.52, 95% CI: -42.00 to 12.96, P = 0.30) or treatment failure (RR 1.37, 95% CI: 0.31-6.07, P = 0.68) in patients treated with PMF compared with patients treated with GOF. CONCLUSIONS Flap-based reconstruction demonstrated improved mortality and treatment outcomes compared to sternal rewiring. However, no significant differences were observed in outcomes between the PMF- and GOF-based reconstructions.
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Affiliation(s)
- Alec S McCranie
- Division of Plastic and Reconstructive Surgery, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | | | - Brandon Wolfe
- Division of Plastic and Reconstructive Surgery, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - Rafael D Malgor
- Division of Vascular Surgery and Endovascular Therapy, University of Colorado, Anschutz Medical Center, Aurora, CO, USA
| | - David W Mathes
- Division of Plastic and Reconstructive Surgery, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - Julian Winocour
- Division of Plastic and Reconstructive Surgery, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - Jason W Yu
- Division of Plastic and Reconstructive Surgery, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - Nargis Kalia
- Division of Plastic and Reconstructive Surgery, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - Christodoulos Kaoutzanis
- Division of Plastic and Reconstructive Surgery, University of Colorado Anschutz Medical Campus, Aurora, CO, USA.
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Yoon DW, Kim TH, Cha MJ, Kim GH, Lee B, Kim HG, Kwon M, Jang D, Park B. Three-dimensional printed pure-titanium implantation for chest wall reconstruction involving the sternum and ribs: a novel approach. Interdiscip Cardiovasc Thorac Surg 2024; 38:ivae037. [PMID: 38561175 PMCID: PMC11009014 DOI: 10.1093/icvts/ivae037] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/19/2023] [Accepted: 02/28/2024] [Indexed: 04/04/2024]
Abstract
Chest wall reconstruction is challenging due to the complex shape and large defect size. The three-dimensional printing technology enables the fabrication of customized implants, and 3D-printed pure-titanium could provide superior mechanical properties to conventional materials. The aim of this study was to evaluate long-term outcomes of patients undergoing chest wall reconstruction with a 3D-printed pure-titanium implant. Between August 2018 and May 2021, 5 patients underwent surgery due to sternal metastasis (n = 3), postoperative sternal wound infection (n = 1) and deformity (n = 1). The customized implant was designed and constructed based on the size and shape of the chest wall defect measured on computed tomography. All patients demonstrated uneventful recovery without complications during the hospital course. During the median follow-up of 20 months, 1 patient underwent revision surgery due to implant breakage, and 1 removed the implant due to trauma-related chest wall infection. One patient died from cancer progression, while 3 patients are alive without any implant-related complications. Chest wall reconstruction using a 3D-printed pure-titanium implant could be a novel alternative for patients with various conditions affecting the sternum and ribs.
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Affiliation(s)
- Dong Woog Yoon
- Department of Thoracic and Cardiovascular Surgery, Chung-Ang University Hospital, Chung-Ang University College of Medicine, Seoul, Republic of Korea
| | - Tae Ho Kim
- Department of Thoracic and Cardiovascular Surgery, Chung-Ang University Hospital, Chung-Ang University College of Medicine, Seoul, Republic of Korea
| | - Min Jae Cha
- Department of Radiology, Chung-Ang University Hospital, Chung-Ang University College of Medicine, Seoul, Republic of Korea
| | - Gun-Hee Kim
- Functional Materials and Components R&D Group, Korea Institute of Industrial Technology, Republic of Korea
| | - ByoungSoo Lee
- Functional Materials and Components R&D Group, Korea Institute of Industrial Technology, Republic of Korea
| | - Hyung Giun Kim
- Functional Materials and Components R&D Group, Korea Institute of Industrial Technology, Republic of Korea
| | | | | | - Byungjoon Park
- Department of Thoracic and Cardiovascular Surgery, Chung-Ang University Hospital, Chung-Ang University College of Medicine, Seoul, Republic of Korea
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5
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Zhao Y, Xie S, Zheng H, Zhang K, Gao X, Liu W, Dai W, Yu H, Shi Q, Hu B, Li Q, Xie T, Wei X. Extended radical resection and chest wall reconstruction for a pulmonary sarcomatoid carcinoma: a case report. Surg Case Rep 2024; 10:64. [PMID: 38494556 PMCID: PMC10944816 DOI: 10.1186/s40792-024-01866-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2024] [Accepted: 03/08/2024] [Indexed: 03/19/2024] Open
Abstract
BACKGROUND Pulmonary sarcomatoid carcinoma (PSC) is a rare and highly malignant type of non-small cell lung cancer (NSCLC), for which the treatment of choice is surgery. For peripheral PSC growing outward and invading the chest wall, a complete resection of the affected lung lobes and the invaded chest wall can improve long-term prognosis. However, when the extent of the resected chest wall is large, reconstruction is often required to reduce the risk of postoperative complications. Here, we present a case of PSC invading the chest wall treated with successful extended radical resection for lung cancer and chest wall reconstruction. CASE PRESENTATION A 58-year-old male patient with a nodule in the right upper lobe that had been identified on physical examination 2 years before presentation presented to our hospital with a recent cough, expectoration, and chest pain. Imaging revealed a mass in the right upper lobe that had invaded the chest wall. Preoperative puncture pathology revealed poorly differentiated NSCLC. We performed extended radical resection for lung cancer under open surgery and reconstructed the chest wall using stainless steel wire and polypropylene meshes. The procedure was uneventful, and the patient was discharged 7 days postoperatively. Furthermore, the final pathology revealed PSC. CONCLUSIONS This case underscores the feasibility of surgical R0 resection in patients with PSC with chest wall invasion and no lymph node metastasis, potentially enhancing long-term outcomes. The novel aspect of this case lies in the individualized chest wall reconstruction for a large defect, using cost-effective materials that offered satisfactory structural support and postoperative recovery, thereby providing a valuable reference for similar future surgical interventions.
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Affiliation(s)
- Yingzhi Zhao
- Department of Thoracic Surgery, Sichuan Clinical Research Center for Cancer, Sichuan Cancer Hospital & Institute, Sichuan Cancer Center, Affiliated Cancer Hospital of the University of Electronic Science and Technology of China, No. 55, Section 4, South Renmin Rd, Chengdu, 610041, China
| | - Shaohua Xie
- Department of Thoracic Surgery, Sichuan Clinical Research Center for Cancer, Sichuan Cancer Hospital & Institute, Sichuan Cancer Center, Affiliated Cancer Hospital of the University of Electronic Science and Technology of China, No. 55, Section 4, South Renmin Rd, Chengdu, 610041, China
| | - Haoqian Zheng
- Department of Thoracic Surgery, Sichuan Clinical Research Center for Cancer, Sichuan Cancer Hospital & Institute, Sichuan Cancer Center, Affiliated Cancer Hospital of the University of Electronic Science and Technology of China, No. 55, Section 4, South Renmin Rd, Chengdu, 610041, China
| | - Kaixin Zhang
- Graduate School, Chengdu Medical College, Chengdu, Sichuan, China
| | - Xin Gao
- Department of Thoracic Surgery, Sichuan Clinical Research Center for Cancer, Sichuan Cancer Hospital & Institute, Sichuan Cancer Center, Affiliated Cancer Hospital of the University of Electronic Science and Technology of China, No. 55, Section 4, South Renmin Rd, Chengdu, 610041, China
| | - Wenwu Liu
- Department of Thoracic Surgery, Sichuan Clinical Research Center for Cancer, Sichuan Cancer Hospital & Institute, Sichuan Cancer Center, Affiliated Cancer Hospital of the University of Electronic Science and Technology of China, No. 55, Section 4, South Renmin Rd, Chengdu, 610041, China
| | - Wei Dai
- Department of Thoracic Surgery, Sichuan Clinical Research Center for Cancer, Sichuan Cancer Hospital & Institute, Sichuan Cancer Center, Affiliated Cancer Hospital of the University of Electronic Science and Technology of China, No. 55, Section 4, South Renmin Rd, Chengdu, 610041, China
| | - Hongfan Yu
- School of Public Health, Chongqing Medical University, Chongqing, China
| | - Qiuling Shi
- Department of Thoracic Surgery, Sichuan Clinical Research Center for Cancer, Sichuan Cancer Hospital & Institute, Sichuan Cancer Center, Affiliated Cancer Hospital of the University of Electronic Science and Technology of China, No. 55, Section 4, South Renmin Rd, Chengdu, 610041, China
- State Key Laboratory of Ultrasound in Medicine and Engineering, College of Biomedical Engineering, Chongqing Medical University, Chongqing, China
- School of Public Health, Chongqing Medical University, Chongqing, China
| | - Bin Hu
- Department of Thoracic Surgery, Sichuan Clinical Research Center for Cancer, Sichuan Cancer Hospital & Institute, Sichuan Cancer Center, Affiliated Cancer Hospital of the University of Electronic Science and Technology of China, No. 55, Section 4, South Renmin Rd, Chengdu, 610041, China
| | - Qiang Li
- Department of Thoracic Surgery, Sichuan Clinical Research Center for Cancer, Sichuan Cancer Hospital & Institute, Sichuan Cancer Center, Affiliated Cancer Hospital of the University of Electronic Science and Technology of China, No. 55, Section 4, South Renmin Rd, Chengdu, 610041, China
| | - Tianpeng Xie
- Department of Thoracic Surgery, Sichuan Clinical Research Center for Cancer, Sichuan Cancer Hospital & Institute, Sichuan Cancer Center, Affiliated Cancer Hospital of the University of Electronic Science and Technology of China, No. 55, Section 4, South Renmin Rd, Chengdu, 610041, China.
| | - Xing Wei
- Department of Thoracic Surgery, Sichuan Clinical Research Center for Cancer, Sichuan Cancer Hospital & Institute, Sichuan Cancer Center, Affiliated Cancer Hospital of the University of Electronic Science and Technology of China, No. 55, Section 4, South Renmin Rd, Chengdu, 610041, China.
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6
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Kaiser LR. Is there an 'ideal' material for chest wall reconstruction? Eur J Cardiothorac Surg 2023; 64:ezad397. [PMID: 38014755 DOI: 10.1093/ejcts/ezad397] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/15/2023] [Accepted: 11/27/2023] [Indexed: 11/29/2023] Open
Affiliation(s)
- Larry R Kaiser
- Department of Surgery, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA
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Vanstraelen S, Bains MS, Dycoco J, Adusumilli PS, Bott MJ, Downey RJ, Huang J, Isbell JM, Molena D, Park BJ, Rusch VW, Sihag S, Allen RJ, Cordeiro PG, Coriddi MR, Dayan JH, Disa JJ, Matros E, McCarthy CM, Nelson JA, Stern C, Shahzad F, Mehrara B, Jones DR, Rocco G. Biologic versus synthetic prosthesis for chest wall reconstruction: a matched analysis. Eur J Cardiothorac Surg 2023; 64:ezad348. [PMID: 37846030 PMCID: PMC11032705 DOI: 10.1093/ejcts/ezad348] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/16/2023] [Revised: 10/11/2023] [Accepted: 10/13/2023] [Indexed: 10/18/2023] Open
Abstract
OBJECTIVES The aim of this study was to compare postoperative outcomes between biologic and synthetic reconstructions after chest wall resection in a matched cohort. METHODS All patients who underwent reconstruction after full-thickness chest wall resection from 2000 to 2022 were reviewed and stratified by prosthesis type (biologic or synthetic). Biologic prostheses were of biologic origin or were fully absorbable and incorporable. Integer matching was performed to reduce confounding. The study end point was surgical site complications requiring reoperation. Multivariable analysis was performed to identify associated risk factors. RESULTS In total, 438 patients underwent prosthetic chest wall reconstruction (unmatched: biologic, n = 49; synthetic, n = 389; matched: biologic, n = 46; synthetic, n = 46). After matching, the median (interquartile range) defect size was 83 cm2 (50-142) for the biologic group and 90 cm2 (48-146) for the synthetic group (P = 0.97). Myocutaneous flaps were used in 33% of biologic reconstructions (n = 15) and 33% of synthetic reconstructions (n = 15) in the matched cohort (P = 0.99). The incidence of surgical site complications requiring reoperation was not significantly different between biologic and synthetic reconstructions in the unmatched (3 [6%] vs 29 [7%]; P = 0.99) and matched (2 [4%] vs 4 [9%]; P = 0.68) cohorts. On the multivariable analysis, operative time [adjusted odds ratio (aOR) = 1.01, 95% confidence interval (CI), 1.00-1.01; P = 0.006] and operative blood loss (aOR = 1.00, 95% CI, 1.00-1.00]; P = 0.012) were associated with higher rates of surgical site complications requiring reoperation; microvascular free flaps (aOR = 0.03, 95% CI, 0.00-0.42; P = 0.024) were associated with lower rates. CONCLUSIONS The incidence of surgical site complications requiring reoperation was not significantly different between biologic and synthetic prostheses in chest wall reconstructions.
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Affiliation(s)
- Stijn Vanstraelen
- Thoracic Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Manjit S Bains
- Thoracic Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Joe Dycoco
- Thoracic Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Prasad S Adusumilli
- Thoracic Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Matthew J Bott
- Thoracic Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Robert J Downey
- Thoracic Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - James Huang
- Thoracic Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - James M Isbell
- Thoracic Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Daniela Molena
- Thoracic Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Bernard J Park
- Thoracic Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Valerie W Rusch
- Thoracic Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Smita Sihag
- Thoracic Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Robert J Allen
- Plastic Surgery Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Peter G Cordeiro
- Plastic Surgery Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Michelle R Coriddi
- Plastic Surgery Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Joseph H Dayan
- Plastic Surgery Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Joseph J Disa
- Plastic Surgery Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Evan Matros
- Plastic Surgery Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Colleen M McCarthy
- Plastic Surgery Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Jonas A Nelson
- Plastic Surgery Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Carrie Stern
- Plastic Surgery Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Farooq Shahzad
- Plastic Surgery Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Babak Mehrara
- Plastic Surgery Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - David R Jones
- Thoracic Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Gaetano Rocco
- Thoracic Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA
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Andreas MN, Böhmer D, Pratschke J, Rückert JC, Elsner A. Advanced lung cancer patient benefits from minimally invasive costal resection and reconstruction: an effective palliative approach for costal metastasis. J Cardiothorac Surg 2023; 18:310. [PMID: 37950298 PMCID: PMC10636914 DOI: 10.1186/s13019-023-02422-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2023] [Accepted: 11/03/2023] [Indexed: 11/12/2023] Open
Abstract
We hereby describe the resection and reconstruction of a rib infiltrated by a lung cancer metastasis. Despite prior radiation therapy aimed at mitigating pain from rib infiltration in a stage IV non-small cell lung cancer patient, results were unsatisfactory. Employing a minimally invasive palliative strategy, we executed a successful operation to address this issue. This technique presents a viable alternative for patients experiencing recurrent pain post radiation therapy.
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Affiliation(s)
- Marco N Andreas
- Department of Surgery, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität Zu Berlin, Augustenburger Platz 1, 13353, Berlin, Germany.
| | - Dirk Böhmer
- Department of Radiation Oncology, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität Zu Berlin, Hindenburgdamm 30, 12203, Berlin, Germany
| | - Johann Pratschke
- Department of Surgery, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität Zu Berlin, Augustenburger Platz 1, 13353, Berlin, Germany
| | - Jens C Rückert
- Department of Surgery, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität Zu Berlin, Augustenburger Platz 1, 13353, Berlin, Germany
| | - Aron Elsner
- Department of Surgery, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität Zu Berlin, Augustenburger Platz 1, 13353, Berlin, Germany
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Batta R, Njoum Y, Deek R, Awad F, Bakri IA, Maree M. Follicular thyroid carcinoma with sternal metastasis: A case report. Int J Surg Case Rep 2023; 109:108625. [PMID: 37566985 PMCID: PMC10425392 DOI: 10.1016/j.ijscr.2023.108625] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2023] [Revised: 07/29/2023] [Accepted: 07/31/2023] [Indexed: 08/13/2023] Open
Abstract
INTRODUCTION AND IMPORTANCE Sternal metastasis of follicular thyroid cancer (FTC) is rare as only 15 cases have been reported in the literature in which most cases of sternal metastasis occurs form breast and lung cancer. Surgical excision of the metastatic mass provides the best option due to its curative benefit, symptomatic palliation, and better response to radioactive iodine. CASE PRESENTATION Herein, we present a 77-year-old female patient with a known history of follicular thyroid carcinoma with isolated sternal metastasis treated with total thyroidectomy and en-bloc resection of the metastasis, followed by chest wall reconstruction using pectoralis major muscle flap. CLINICAL DISCUSSION Surgical excision of metastatic FTC to sternum with chest wall reconstruction was seldom reported as the treatment of choice. In most cases in the literature, mesh was used. However, in our patient mesh was not used taking into consideration the drastic consequences of wound infection and the possible need for mesh retrieval in such a dangerous area in proximity to the mediastinum. We believe that myo-adipo-facial flap is a more reasonable and safe option. CONCLUSION In patients with FTC, large tumors and bone metastases are factors that indicate poor prognostic factors, both of which were present in our patient. However, surgical excision provides hope for a better quality of life as it enhances subsequent Radioactive Iodine (RAI) therapy.
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Affiliation(s)
- Rita Batta
- General surgery department, Al-Makassed Hospital, Jerusalem, Palestine.
| | - Yumna Njoum
- Faculty of Medicine, Al-Quds University, Jerusalem, Palestine
| | - Rahmeh Deek
- Faculty of Medicine, Al-Quds University, Jerusalem, Palestine
| | - Fadi Awad
- Faculty of Medicine, Al-Quds University, Jerusalem, Palestine
| | - Izzeddin A Bakri
- Pathology department, Al-Makassed Hospital, Jerusalem, Palestine
| | - Mohammed Maree
- General surgery department, Al-Makassed Hospital, Jerusalem, Palestine
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10
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Theodorou CM, Lawrence YS, Brown EG. Chest wall reconstruction in pediatric patients with chest wall tumors: A systematic review. J Pediatr Surg 2022:S0022-3468(22)00736-9. [PMID: 36585305 DOI: 10.1016/j.jpedsurg.2022.11.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/27/2022] [Revised: 11/12/2022] [Accepted: 11/20/2022] [Indexed: 11/24/2022]
Abstract
BACKGROUND Resection of pediatric chest wall tumors can result in large defects requiring reconstruction for function and cosmesis. Multiple reconstructive methods have been described. We performed a systematic review of the literature to describe commonly used approaches and outcomes. METHODS A systematic literature search was performed for English-language publications describing chest wall tumor resection and reconstruction using implantable materials in patients ≤21 years, excluding soft tissue resection only, sternal resection, and reconstruction by primary repair or muscle flaps alone. Data were collected on diagnoses, reconstructive method, and outcomes. Rigid chest wall reconstruction was compared to mesh reconstruction. RESULTS There were 55 articles with 188 patients included. The median age was 12 years. Most tumors were malignant (n = 172, 91.5%), most commonly Ewing's sarcoma (n = 65, 34.6%), followed by unspecified sarcomas (n = 34, 18.1%), Askin's tumor (n = 16, 8.5%; a subset of Ewing's sarcoma) and osteosarcoma (n = 16, 8.5%). A median of 3 ribs were resected (range 1-12). Non-rigid meshes were most common (n = 138, 73.4%), followed by rigid prostheses (n = 50, 26.6%). There were 19 post-operative complications (16.8%) and 22.2% of patients developed scoliosis. There were no significant differences in complications (20.5% rigid vs. 10.6% non-rigid, p = 0.18) or scoliosis (22.7% vs. 14.0%, p = 0.23) by reconstruction method, but complications after rigid reconstruction were more likely to require surgery (90.0% vs. 53.9%, p = 0.09). The median follow-up duration was 24 months. CONCLUSIONS In this review of the literature, there were no significant differences in overall post-operative complications or scoliosis development by reconstruction method, yet complications after rigid reconstruction were more likely to require surgical intervention. LEVEL OF EVIDENCE Level IV.
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Affiliation(s)
- Christina M Theodorou
- University of California Davis Medical Center, Department of Surgery, Division of Pediatric General, Thoracic, and Fetal Surgery, 2335 Stockton Blvd, Sacramento, 95817, CA, United States.
| | - Yemi S Lawrence
- University of California Davis Medical Center, Department of Surgery, Division of Pediatric General, Thoracic, and Fetal Surgery, 2335 Stockton Blvd, Sacramento, 95817, CA, United States
| | - Erin G Brown
- University of California Davis Medical Center, Department of Surgery, Division of Pediatric General, Thoracic, and Fetal Surgery, 2335 Stockton Blvd, Sacramento, 95817, CA, United States
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11
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Nedumaran B, Krishnasamy A, Mahalingam S, Ramasamy M, Kaliaperumal N. Primary intrathoracic synovial cell sarcoma requiring radical resection of the chest wall and diaphragm with reconstruction using titanium mesh. Indian J Thorac Cardiovasc Surg 2022; 38:644-647. [PMID: 36258822 PMCID: PMC9569248 DOI: 10.1007/s12055-022-01378-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2022] [Revised: 05/18/2022] [Accepted: 05/19/2022] [Indexed: 10/18/2022] Open
Abstract
Intrathoracic synovial cell sarcomas are extremely rare tumors with a high rate of recurrence after resection. We report one such case of synovial cell sarcoma arising from the chest wall, which was completely intrathoracic without an external component. The tumor was resected twice and in spite of adjuvant chemo-radiation the tumor recurred. Radical resection of the tumor with reconstruction of the chest wall and diaphragm using titanium mesh and polypropylene mesh respectively was done. A latissimus dorsi flap cover was provided. Titanium mesh is an excellent prosthesis of choice for reconstruction, as it provides stability and better cosmesis of the chest wall. Radical resection can be offered for suitable candidates, with very low morbidity and mortality. Supplementary Information The online version contains supplementary material available at 10.1007/s12055-022-01378-3.
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Affiliation(s)
- Bharathguru Nedumaran
- Department of Cardiothoracic Surgery, Billroth Hospitals, Shenoy nagar, Chennai, India
| | - Arunkumar Krishnasamy
- Department of Cardiothoracic Surgery, Billroth Hospitals, Shenoy nagar, Chennai, India
| | | | - Mahadevan Ramasamy
- Department of Cardiothoracic Surgery, Billroth Hospitals, Shenoy nagar, Chennai, India
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12
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Essa RA, Ahmed SK, Mohamed MG, Bapir DH. Chest wall reconstruction in a young man after high-velocity gunshot using a combination latissimus dorsi flaps and titanium plates: A case report. Int J Surg Case Rep 2022; 94:107030. [PMID: 35427891 PMCID: PMC9026916 DOI: 10.1016/j.ijscr.2022.107030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2022] [Revised: 03/31/2022] [Accepted: 03/31/2022] [Indexed: 11/18/2022] Open
Abstract
Chest trauma, penetrating or blunt, is common in this era of road traffic accidents, terrorism, and hunting in Iraq. During the last decade, many novel surgical procedures and materials were used to reconstruct or stabilize the chest wall to improve integration, maintain the stability of the chest wall, and reduce infections. However, no precise guidelines for managing chest wall diseases are still available to date. Here, we present a 24-year-old male who underwent chest wall reconstruction using a combination of latissimus dorsi flap and titanium plates, which were to cover the chest wall after a high-velocity gunshot. This patient was in shock too, with a lung contusion and massive hemorrhage. The sucking open chest wound lead to grossly disturbed respiratory mechanics. Such patients usually die on the way due to hemodynamic instability. In this particular case, adequate resuscitation and prompt thoracotomy saved the patient's life. This case report is important because, as we already mentioned, thoracic trauma alone is the cause of death in 25% of patients, and in another 25%, it's a contributing factor in a polytrauma death. This amounts to very high mortality. Our patient received a major laceration of the left lung. Our patient had a full recovery from this life-threatening situation.
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Affiliation(s)
- Rawand Abdulrahman Essa
- Department of Emergency, Rania Teaching Hospital, Rania, Sulaimani, Kurdistan-region, Iraq; Department of Cardiothoracic and Vascular Surgery, Rania Medical City Hospital, Rania, Sulaimani, Kurdistan-Region, Iraq; Department of Emergency, Rania Pediatric & Maternity Teaching Hospital, Rania, Sulaimani, Kurdistan-region, Iraq; Department of Biotechnology, Institute of Science and Modern Technology, Rojava University, Qamishlo, Syria
| | - Sirwan Khalid Ahmed
- Department of Emergency, Rania Teaching Hospital, Rania, Sulaimani, Kurdistan-region, Iraq; Department of Cardiothoracic and Vascular Surgery, Rania Medical City Hospital, Rania, Sulaimani, Kurdistan-Region, Iraq; Department of Emergency, Rania Pediatric & Maternity Teaching Hospital, Rania, Sulaimani, Kurdistan-region, Iraq; Department of Biotechnology, Institute of Science and Modern Technology, Rojava University, Qamishlo, Syria.
| | - Mona Gamal Mohamed
- Department of Nursing, RAK Medical and Health Sciences University, Ras Al Khaimah, United Arab Emirates
| | - Dunya Hars Bapir
- Department of Biotechnology, Institute of Science and Modern Technology, Rojava University, Qamishlo, Syria
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13
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Rim G, Park HJ. Repair of Recurrent Pectus Excavatum with a Huge Chest Wall Defect in a Patient with a Previous Ravitch and Pectus Bar Repair: A Case Report. J Chest Surg 2022; 55:246-249. [PMID: 35292602 PMCID: PMC9178308 DOI: 10.5090/jcs.21.085] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2021] [Revised: 12/09/2021] [Accepted: 12/14/2021] [Indexed: 11/16/2022] Open
Abstract
Recurrent pectus excavatum (PE) after a Ravitch operation is not uncommon. Extensive costal cartilage resection from the previous Ravitch procedure can lead to an irregular, unstable chest wall depressions with a varying degree of deformity. The optimal approach to cover the chest wall defect and remodel the deformity, remains unknown. We report the case of a 27-year-old woman seeking surgery for the third time for recurrent PE. The patient presented with 2-time recurrent pectus excavatum following a failed Ravitch procedure and subsequent pectus bar repair. The entire chest wall reconstruction and remodeling entailed covering the chest wall defect with 2 titanium plates across both sides of the rib cage, and lifting and fixing the depressed chest wall with 2 parallel pectus bars.
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Affiliation(s)
- Gongmin Rim
- Department of Thoracic and Cardiovascular Surgery, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Hyung Joo Park
- Department of Thoracic and Cardiovascular Surgery, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
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14
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Dantis K, Brahmachari S, Raju A, Shankari S. An innovative technique of chest wall stabilization and reconstruction in traumatic flail chest: The figure-of-eight suture with polypropylene mesh and musculofascial flap. Chin J Traumatol 2022; 25:122-4. [PMID: 34034947 DOI: 10.1016/j.cjtee.2021.04.009] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/29/2020] [Revised: 03/29/2021] [Accepted: 04/15/2021] [Indexed: 02/04/2023] Open
Abstract
Surgical stabilization of the flail chest is challenging and has no established guidelines. Chest wall integrity and stability are the main factors that ensure the protection of intrathoracic organs and an adequate respiratory function. Here, we report a novel chest wall reconstruction technique in a 45-year-old man with a traumatic left flail chest and open pneumothorax diagnosed both clinically and radiographically. Rib approximation and chest wall reconstruction was done using intercostal figure-of-eight suture and polypropylene mesh with vascularized musculofascial flap. The patient improved gradually and was discharged after three weeks of total hospital stay. He returned to regular working after a month with no evidence of respiratory distress or paradoxical chest movement. Follow-up visit at one year revealed no lung hernia or paradoxical chest movement. This is a novel, feasible and cost-effective modification of chest wall reconstruction that can be adopted for thoracic wall repair in case of open flail chest, which needs emergency surgical interventions even in resource constraint settings.
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15
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Sarwal D, Yu N, Veeramachaneni N, Aslinia F. The Key Role of Upper Endoscopy in Diagnosing Gastric Herniation and Volvulus in Acute Gastrointestinal Obstruction. Case Rep Gastroenterol 2022; 16:252-257. [PMID: 35611124 PMCID: PMC9082190 DOI: 10.1159/000521917] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/20/2021] [Accepted: 01/07/2022] [Indexed: 11/24/2022] Open
Abstract
The diagnosis of gastric volvulus can be a clinical challenge as it is rare, and the symptoms are often nonspecific and intermittent. Upper endoscopy is a minimally invasive intervention that may be repeated more than once to provide key information and ultimately establish such a diagnosis. To emphasize the role of upper endoscopy in surgical cases with recurrent upper gastrointestinal obstructions, we present a case of intermittent gastric volvulus in a patient with a remote history of complex chest wall reconstruction for invasive breast cancer using an omental flap. She presented with substernal chest pain, belching, nausea, and vomiting. Although the initial imaging suggested duodenal obstruction, exploratory laparotomy and intraoperative upper endoscopy did not show any pathology in the stomach or duodenum. Repeat upper endoscopy due to recurrence of obstructive symptoms shortly after the initial exploratory laparotomy revealed a gastric volvulus. This resulted in abnormal duodenal orientation which caused intermittent duodenal obstruction while the pathology was in the stomach. Gastric volvulus may be spontaneously reducible, leading to discordance in findings during the clinical course. This could explain the absence of visible twisting on initial exploratory laparotomy in this patient and the subsequent findings of volvulus on upper endoscopy. Thus, it is important to consider gastric volvulus as a possible cause of symptoms despite initial negative findings as it is a dynamic process and may only be discovered through relook upper endoscopy and imaging.
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16
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Topolnitskiy E, Chekalkin T, Marchenko E, Yasenchuk Y. Repair of huge thoracic defect combined with hernia after multimodality treatment of breast cancer. Respir Med Case Rep 2021; 34:101558. [PMID: 34877252 DOI: 10.1016/j.rmcr.2021.101558] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2021] [Revised: 11/16/2021] [Accepted: 11/18/2021] [Indexed: 11/24/2022] Open
Abstract
A case of the successful reconstruction of an extensive chest wall defect combined with a ventral hernia in a patient after multimodality treatment of breast cancer complicated by sternal and costal osteomyelitis is presented. To recover the chest mechanics, with emphasis on the supporting function, and to repair the hernial defect, customized reinforced “sandwich” TiNi rib endografts and knitted TiNi surgical mesh were used. A five-year follow-up indicated no recurrence of osteomyelitis or ventral hernia, and no failure/migration of the implants or instability of the thorax. Excellent clinical and functional outcomes were achieved pursuant to the Enneking score.
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17
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Malovrh T, Stupnik T, Podobnik B, Kalisnik JM. Postoperative transverse sternal nonunion with a chest wall defect managed by a tibial locking plate and a Gore-Tex dual mesh membrane: a case report. J Cardiothorac Surg 2021; 16:345. [PMID: 34872576 PMCID: PMC8647373 DOI: 10.1186/s13019-021-01730-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2021] [Accepted: 11/21/2021] [Indexed: 11/29/2022] Open
Abstract
Background Transverse sternal nonunion is a rare but disabling complication of chest trauma or a transverse sternotomy. Fixation methods, mainly used to manage the more common longitudinal sternal nonunion, often fail, leaving the surgical treatment of transverse nonunion to be a challenge.
Case presentation We present a case of a highly-disabling, postoperative chest wall defect resulting from transverse sternal nonunion after a transverse thoracosternotomy (clamshell incision) and a concomitant rib resection. Following unsuccessful surgical attempts, the sternal nonunion was fixed with a tibial locking plate and bone grafted, while the post-rib resection chest defect was reconstructed with a Gore-Tex dual mesh membrane. Adequate chest stability was achieved, enabling complete healing of the sternal nonunion and the patient’s complete recovery. Conclusion We believe it is important to address both in the rare case of combined postoperative transverse sternal nonunion and the chest wall defect after rib resection. A good outcome was achieved in our patient by fixing the nonunion with an appropriately sized and shaped locking plate with bone grafting and covering the chest defect with a dual mesh membrane.
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Affiliation(s)
- Tomaz Malovrh
- Department of Traumatology, University Medical Centre Ljubljana, Zaloska cesta 7, 1000, Ljubljana, Slovenia. .,Medical Faculty, University of Ljubljana, Ljubljana, Slovenia.
| | - Tomaz Stupnik
- Department of Thoracic Surgery, University Medical Centre Ljubljana, Ljubljana, Slovenia
| | - Boris Podobnik
- Medical Faculty, University of Ljubljana, Ljubljana, Slovenia
| | - Jurij Matija Kalisnik
- Medical Faculty, University of Ljubljana, Ljubljana, Slovenia.,Cardiac Surgery, Cardiovascular Center, Klinikum Nürnberg - Paracelsus Medical University, Nuremberg, Germany
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18
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Nayak R, Choe SI, Shargall Y. Complications of Chest Wall Resection in Conjunction with Pulmonary Resection. Thorac Surg Clin 2021; 31:393-8. [PMID: 34696851 DOI: 10.1016/j.thorsurg.2021.07.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Techniques for chest wall resection and reconstruction have evolved over the years. Chest wall resection in conjunction with pulmonary resection has several complications, including pulmonary and infectious. Risk factors for complications are related to the size of the defect, number of ribs resected, and the addition of a pulmonary resection. Material used for reconstruction does not impact the overall complication rate.
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19
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Allen LC, Milton R, Bourke G. Multidisciplinary reconstructive management of residual recalcitrant empyema cavity: A retrospective observational cohort study. J Plast Reconstr Aesthet Surg 2021; 75:1057-1063. [PMID: 34872875 DOI: 10.1016/j.bjps.2021.09.073] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2020] [Revised: 05/13/2021] [Accepted: 09/27/2021] [Indexed: 10/20/2022]
Abstract
BACKGROUND Patients with stage III empyema require chest wall fenestration to enable lung re-expansion and continuous drainage of the persisting empyema cavity. This chronic wound negatively affects patients' exercise tolerance, ability to carry out activities of daily living, and quality of life. METHODS Eight consecutive patients underwent chest wall reconstruction following fenestration and were followed up over a minimum of 12 months. This study included adult patients (over 18 years of age). There were no exclusion criteria. Data were collected retrospectively. RESULTS Eight patients (six male and two female), with a mean age of 56 years (range, 22-76), were included. All of them had comorbidities including history of neoplasia (n = 6), atrial fibrillation (n = 3), and hypertension (n = 2). Aetiology of empyema included lung cancer resection complicated by bronchopleural fistula (n = 4), pneumonia (n = 2), and pleural effusion (n = 2). Five patients had a low metabolic reserve evident by a low BMI (range, 16-22), and a median malnutrition universal screen tool (MUST) score of 2 (range, 1-4). Following intensive infection control and nutritional support, patients underwent reconstruction 11 months (median; range 5-51) after fenestration. Seven patients were followed up and had no recurrence of empyema and bronchopleural fistula. They all reported significant improvements in their quality of life, and their Eastern Cooperative Oncology Group (ECOG) performance status improved from three to one. One patient died 56 days post-reconstruction from cardiorespiratory failure, which required readmission to hospital. CONCLUSION We demonstrate that free tissue reconstruction including multidisciplinary input and optimisation at all stages of care successfully closes residual recalcitrant empyema cavity without recurrence and leads to significant improvements in the quality of life.
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Affiliation(s)
- Luke Ce Allen
- Leeds School of Medicine, Faculty of Medicine and Health Sciences, University of Leeds, Leeds LS2 9NL, UK.
| | - Richard Milton
- Department of Thoracic Surgery, Leeds Teaching Hospitals Trust, Leeds LS9 7TF, UK
| | - Grainne Bourke
- Leeds School of Medicine, Faculty of Medicine and Health Sciences, University of Leeds, Leeds LS2 9NL, UK; Department of Plastic and Reconstructive Surgery, Leeds Teaching Hospitals Trust, Leeds LS9 7TF, UK
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20
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Schirren M, Jefferies B, Safi S, Wörtler K, Hoffmann H. [Surgical treatment of chest wall tumors]. Chirurg 2021; 93:623-632. [PMID: 34636942 DOI: 10.1007/s00104-021-01499-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/11/2021] [Indexed: 11/29/2022]
Abstract
The term chest wall tumor summarizes a heterogeneous group of malignant and benign tumors, whereby primary and secondary chest wall tumors are differentiated. The incidence of secondary chest wall tumors is higher than that of primary tumors. Primary chest wall tumors can arise from any anatomic structure of the chest wall. Surgical resection is usually the treatment of choice. Resection status and tumor differentiation are relevant prognostic factors. Treatment of secondary chest wall tumors is performed depending on the patient's symptoms and prognosis of the underlying disease. Lung carcinomas infiltrating the chest wall can be resected primarily or secondarily as part of multimodal therapeutic strategies. Anatomic lung resections combined with chest wall resection have a higher mortality than standard resections. Chest wall reconstruction after resection has the goal of reducing paradoxical respiratory motion, although not every chest wall defect requires reconstruction.
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Affiliation(s)
- Moritz Schirren
- Sektion Thoraxchirurgie, Klinikum rechts der Isar, Technische Universität München, Ismaninger Straße 22, 81675, München, Deutschland.
| | - Benedikt Jefferies
- Sektion Thoraxchirurgie, Klinikum rechts der Isar, Technische Universität München, Ismaninger Straße 22, 81675, München, Deutschland
| | - Seyer Safi
- Sektion Thoraxchirurgie, Klinikum rechts der Isar, Technische Universität München, Ismaninger Straße 22, 81675, München, Deutschland
| | - Klaus Wörtler
- Institut für Radiologie, Klinikum rechts der Isar, Technische Universität München, Ismaninger Straße 22, 81675, München, Deutschland
| | - Hans Hoffmann
- Sektion Thoraxchirurgie, Klinikum rechts der Isar, Technische Universität München, Ismaninger Straße 22, 81675, München, Deutschland
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21
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Liu Y, Wang W, Long W, Cai B, Chen C, Wang W, Guan S, Luo J, Chen K. Chest wall reconstruction with digitally designed materials for straight back syndrome with tracheal stenosis: a case report. Ann Transl Med 2021; 9:1357. [PMID: 34532494 PMCID: PMC8422149 DOI: 10.21037/atm-21-3976] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/17/2021] [Accepted: 08/20/2021] [Indexed: 11/06/2022]
Abstract
Severe symptoms of straight back syndrome (SBS) occur through compression of the mediastinal structures. The treatment is to relieve compression, but surgical relief has not been reported. A 29-year-old woman was admitted to hospital because of dyspnea for 2 years. Physical examination showed the physiological curvature of the spine had disappeared and imaging examination confirmed that the spine was straight, the distance between the spine and the anterior chest wall was shortened, and the lower part of the trachea was obviously compressed with a severe stenosis. The chest wall was simulated by 3D technology, and a model was obtained by 3D printing. The surgical resection was simulated on the model, and the required replacement material was digitally designed and processed. The upper half of the sternum, the first and second costal cartilages, and the thymus were excised. After the chest wall defect was repaired with the digital material, the ascending aorta was suspended on the reconstruction to relieve the tracheal compression. The operation was completed in 135 min without any complications. All symptoms disappeared after operation. Postoperative imaging examination showed complete resolution of the tracheal stenosis. The patient was discharged 10 days after operation. Surgical reconstruction of the anterior chest wall is a good method for treating tracheal stenosis in SBS, and digitally produced material is ideal for the reconstruction.
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Affiliation(s)
- Yang Liu
- Department of Chest Wall Surgery, Guangdong Second Provincial People's Hospital, Guangzhou, China
| | - Wenlin Wang
- Department of Chest Wall Surgery, Guangdong Second Provincial People's Hospital, Guangzhou, China
| | - Weiguang Long
- Department of Chest Wall Surgery, Guangdong Second Provincial People's Hospital, Guangzhou, China
| | - Bin Cai
- Department of Chest Wall Surgery, Guangdong Second Provincial People's Hospital, Guangzhou, China
| | - Chunmei Chen
- Department of Chest Wall Surgery, Guangdong Second Provincial People's Hospital, Guangzhou, China
| | - Wenjie Wang
- Department of Chest Wall Surgery, Guangdong Second Provincial People's Hospital, Guangzhou, China
| | - Shubin Guan
- Department of Chest Wall Surgery, Guangdong Second Provincial People's Hospital, Guangzhou, China
| | - Juan Luo
- Department of Chest Wall Surgery, Guangdong Second Provincial People's Hospital, Guangzhou, China
| | - Kai Chen
- Department of Chest Wall Surgery, Guangdong Second Provincial People's Hospital, Guangzhou, China
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Nakanishi T, Kuwahara M, Sasaki C, Ando J, Harada M, Takeuchi M. A radiation ulcer that required partial lung resection and recurred in a small residual area of ectopic calcification. Int J Surg Case Rep 2021; 85:106201. [PMID: 34284338 PMCID: PMC8313481 DOI: 10.1016/j.ijscr.2021.106201] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2021] [Revised: 07/10/2021] [Accepted: 07/14/2021] [Indexed: 11/03/2022] Open
Abstract
INTRODUCTION AND IMPORTANCE Surgery for chest radiation ulcers must involve appropriate wide margins, but it is not usually possible to remove all radiation-damaged tissue. Therefore, it is difficult to determine how extensive such surgery should be. There have not been any reports about the recurrence of such ulcers years after surgery. In addition, how ectopic calcification should be treated and the need for partial lung resection in such cases have not been fully elucidated. We report the case of a patient who had a large severe radiation ulcer. CASE PRESENTATION A 46-year-old patient underwent cancer resection and received postoperative radiotherapy. Seventeen years later, a chest ulcer developed. Computed tomography showed a depression of the lung parenchyma, which exhibited old radiation pneumonitis, and pathological fractures of the ribs around the ulcer. We excised a region of skin that exhibited a clear change in color together with an additional 1 cm around this area including 4 ribs and grossly calcified area. The lung was partially resected because of strong adhesion, and the chest wall was reconstructed. Two small calcifications remained and which required additional surgery several years later. CLINICAL DISCUSSION Since multiple surgeries were required, we consider that more generous resection margins were necessary from the beginning. CONCLUSION In such cases, it might be necessary to perform more extensive surgery that includes asymptomatic calcified areas.
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Affiliation(s)
- Takashi Nakanishi
- Department of Plastic Surgery, Nara Prefecture General Medical Center, 897-5, 2Cho-me Shitijo-nishi-chou, Nara 630-8581, Japan
| | - Masamitsu Kuwahara
- Division of Plastic Surgery, Nara Medical University Hospital, 840 Shijocho, Kashihara, Nara 634-8522, Japan.
| | - Chikako Sasaki
- Department of Plastic Surgery, Nara Prefecture General Medical Center, 897-5, 2Cho-me Shitijo-nishi-chou, Nara 630-8581, Japan
| | - Junji Ando
- Division of Plastic Surgery, Nara Medical University Hospital, 840 Shijocho, Kashihara, Nara 634-8522, Japan
| | - Masayuki Harada
- Division of Plastic Surgery, Nara Medical University Hospital, 840 Shijocho, Kashihara, Nara 634-8522, Japan
| | - Mika Takeuchi
- Division of Plastic Surgery, Nara Medical University Hospital, 840 Shijocho, Kashihara, Nara 634-8522, Japan
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Abdel Jalil R, Abou Chaar MK, Al-Qudah O, Kakish H, Elfar S. Chest wall and diaphragm reconstruction; a technique not well established in literature - case report. J Cardiothorac Surg 2021; 16:196. [PMID: 34243804 PMCID: PMC8272294 DOI: 10.1186/s13019-021-01577-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2021] [Accepted: 07/03/2021] [Indexed: 11/15/2022] Open
Abstract
INTRODUCTION Regardless of its rarity, and indolent clinical course, chest wall tumor places high morbidity and burden on patients especially when invasion to a neighboring structure is found. Once detected, surgery is the cornerstone for treatment of such etiology combined with chemo-radiotherapy. In order to maintain intact respiratory function, chest wall reconstruction must be performed whenever resection is done. Herein, we present a case of chest wall tumor that necessitated three ribs and part of hemidiaphragm resection and reconstruction with optimal post-operative results. CASE PRESENTATION A 27-year-old male patient who had chest wall and diaphragm reconstruction for a chest wall Ewing sarcoma, using a single patch of expanded polytetrafluoroethylene (ePTFE) mesh with diaphragm implanted into the middle of the mesh. There were no immediate nor post-operative complications. The patient received post-operative radiotherapy with good functional and cosmetic results. CONCLUSION We present a novel and safe technique for combined chest wall and diaphragmatic resection following excision of an invading tumor while ensuring cosmesis and functionality of the ribcage as well as the diaphragm.
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Affiliation(s)
- Riad Abdel Jalil
- Department of Thoracic Oncology, King Hussein Cancer Center, Queen Rania Al Abdullah Street, P.O. Box 1269, Amman, 11941, Jordan.
| | | | - Obada Al-Qudah
- Department of Thoracic Oncology, King Hussein Cancer Center, Queen Rania Al Abdullah Street, P.O. Box 1269, Amman, 11941, Jordan
| | - Hanna Kakish
- Department of Research, King Hussein Cancer Center, Amman, Jordan
| | - Salam Elfar
- Department of Pharmacy, King Hussein Cancer Center, Amman, Jordan
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Wardoyo S, Kamal AF, Furqon MA, Grantomo J, Hutami WD. Osteosarcoma of the rib: A challenge of diagnosis and surgical intervention: A case report. Int J Surg Case Rep 2021; 81:105777. [PMID: 33887851 DOI: 10.1016/j.ijscr.2021.105777] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2021] [Revised: 03/13/2021] [Accepted: 03/14/2021] [Indexed: 11/21/2022] Open
Abstract
INTRODUCTION AND IMPORTANCE Chest wall tumour could grow from various tissues composing the chest wall. Diagnosis and treatment of patients with chest wall tumour pose several challenges. CASE PRESENTATION We present a case of 55 year old woman with chief complaint of a painfull mass on her chest wall. Patient was diagnosed with osteosarcoma of the ribs. Patient underwent surgery and was hospitalized for seven days before discharged. CLINICAL DISCUSSION Osteosarcoma of the ribs is a rare case with wide resection as the main treatment. In this case, chest wall reconstruction was needed to prevent impaired chest wall mechanical function in respiration. CONCLUSION Diagnosis and treatment of osteosarcoma of the ribs pose challenges. The main treatment of the osteosarcoma of the ribs is wide resection, followed by reconstruction of chest wall when needed. Reconstruction could be performed with autologous tissue, gore-tex, and mesh. The adjuvant chemotherapy was considered to give for better outcome.
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Stanizzi A, Torresetti M, Salati M, Benedetto GD. Use of porcine acellular dermal matrix to repair lung Hernia after minithoracotomy: A case report with 6-Year follow-up. JPRAS Open 2021; 28:56-60. [PMID: 33732854 PMCID: PMC7937533 DOI: 10.1016/j.jpra.2021.01.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2021] [Accepted: 01/21/2021] [Indexed: 11/24/2022] Open
Abstract
Lung hernia following minimally invasive cardiac surgery is rare with few reported cases in the literature. Surgical repair is debated, and several methods have been described including a variety of synthetic and biological materials. We report a case of a 36-year-old woman who developed lung hernia and a strong retraction of the pectoralis major muscle after minithoracotomy that was performed for mitral valve surgery. The herniated lung was reduced and the chest wall defect was repaired with a non-cross linked acellular dermal matrix (ADM) anchored to the thoracic wall. At a 6-year follow-up, she was asymptomatic and without recurrence of the hernia. Our experience suggests that ADMs are a safe and reliable surgical technique for lung hernia repair due to their biological and mechanical properties, even in those secondary hernias to minithoracotomy where a complete muscle coverage of the matrix could not be provided.
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Affiliation(s)
- Antonio Stanizzi
- Clinic of Plastic and Reconstructive Surgery, Department of Experimental and Clinical Medicine, Marche Polytechnic University Medical School, Ancona, Italy
| | - Matteo Torresetti
- Clinic of Plastic and Reconstructive Surgery, Department of Experimental and Clinical Medicine, Marche Polytechnic University Medical School, Ancona, Italy
| | - Michele Salati
- Division of Thoracic Surgery, Ospedali Riuniti di Ancona, via Conca 71, 60126, Ancona Italy
| | - Giovanni Di Benedetto
- Clinic of Plastic and Reconstructive Surgery, Department of Experimental and Clinical Medicine, Marche Polytechnic University Medical School, Ancona, Italy
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Prisciandaro E, Hustache-Castaing R, Michot A, Jougon J, Thumerel M. Chest wall resection and reconstruction for primary and metastatic sarcomas: an 11-year retrospective cohort study. Interact Cardiovasc Thorac Surg 2021; 32:744-752. [PMID: 33532842 DOI: 10.1093/icvts/ivab003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2020] [Revised: 12/05/2020] [Accepted: 12/12/2020] [Indexed: 11/12/2022] Open
Abstract
OBJECTIVES Chest wall sarcomas are rare, aggressive malignancies, the management of which mainly revolves around surgery. Radical tumour excision with free margins represents the optimal treatment for loco-regional clinically resectable disease. The objective of this study was to review our 11-year experience with chest wall resection for primary and metastatic sarcomas, focusing on surgical techniques and strategies for reconstruction. METHODS Retrospective analysis of a comprehensive database of patients who underwent chest wall resection for primary or secondary sarcoma at our Institute from January 2009 to December 2019. RESULTS Out of 26 patients, 21 (81%) suffered from primary chest wall sarcoma, while 5 (19%) had recurring disease. The median number of resected ribs was 3. Sternal resection was performed in 6 cases (23%). Prosthetic thoracic reconstruction was deemed necessary in 24 cases (92%). Tumour recurrence was observed in 15 patients (58%). The median overall survival was 73.6 months. Primary and secondary tumours showed comparable survival (P = 0.49). At univariate analysis, disease recurrence and infiltrated margins on pathological specimens were associated with poorer survival (P = 0.014 and 0.022, respectively). In patients with primary sarcoma, the median progression-free survival was 13.3 months. Associated visceral resections were significantly associated to postoperative complications (P = 0.02). CONCLUSIONS Chest wall resection followed by prosthetic reconstruction is feasible in carefully selected patients and should be performed by experienced surgeons with the aim of achieving free resection margins, resulting in improved long-term outcomes.
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Affiliation(s)
- Elena Prisciandaro
- Division of Thoracic Surgery, Centre Hospitalier Universitaire de Bordeaux, Pessac, France
| | - Romain Hustache-Castaing
- Division of Thoracic Surgery, Centre Hospitalier Universitaire de Bordeaux, Pessac, France.,Université de Bordeaux, Bordeaux, France
| | - Audrey Michot
- Division of Surgery, Bergonié Institute, Bordeaux, France
| | - Jacques Jougon
- Division of Thoracic Surgery, Centre Hospitalier Universitaire de Bordeaux, Pessac, France.,Université de Bordeaux, Bordeaux, France
| | - Matthieu Thumerel
- Division of Thoracic Surgery, Centre Hospitalier Universitaire de Bordeaux, Pessac, France.,Université de Bordeaux, Bordeaux, France
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Gangopadhyay A, Nandy K, Puj K, Sharma M, Jayaprakash D, Salunke A, Jain A, Pandya S. Primary chest wall sarcoma; a single institution experience of 3 years. Cancer Treat Res Commun 2021; 27:100326. [PMID: 33524850 DOI: 10.1016/j.ctarc.2021.100326] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2020] [Revised: 01/22/2021] [Accepted: 01/26/2021] [Indexed: 11/19/2022]
Abstract
INTRODUCTION Primary chest wall sarcoma is a rare entity. It can be classified based on its origin, as bone sarcomas or soft tissue sarcomas. Various prognostic factors have been studied in different case series like age, sex, tumor histology, grade, resection margin status, adjuvant treatment, and others. The present study aimed to analyze common histological types, their management by resection and reconstruction and prognosis, in cases presenting at a regional cancer center in western India. MATERIAL AND METHOD This was an observational study from a prospectively maintained database. 57 patients with chest wall sarcoma treated with curative intent between January 2016 till January 2019 with a minimum follow-up of 3 months were included in the study. The goals of surgical treatment were to obtain a wide resection margin of 3-4 cm, preserve the function of the chest wall and provide stability and rigidity to protect intrathoracic organs. RESULTS The median follow-up of the present patient's cohort was for 20.2 months. Overall two-year survival was 74.7%. Two-year OS and DFS of bone sarcoma were 62.3% and 35% and soft tissue sarcomas were 91% and 71.3%. Ewing's sarcoma had the worst two-year overall survival of 50.6% and chondrosarcoma and fibromatosis had 100% two-year overall survival. CONCLUSION Chest wall sarcoma forms a heterogeneous group of tumors. In the present study, Ewing's sarcoma was the most common histology with the worst survival, since they presented in advanced stages. Management should be multidisciplinary and surgical resection should be aggressive to achieve an R0 resection. Reconstruction of chest wall should aim to provide structural and functional stability with minimal morbidity. Frozen section assessment should be utilized whenever in doubt.
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Affiliation(s)
- Abhishek Gangopadhyay
- Surgical Oncology Resident Doctor, Department of Surgical Oncology, Gujarat Cancer and Research Institute, Ahmedabad, Gujarat, India.
| | - Kunal Nandy
- Surgical Oncology Resident Doctor, Department of Surgical Oncology, Gujarat Cancer and Research Institute, Ahmedabad, Gujarat, India.
| | - Ketul Puj
- Assistant Professor, Department of Surgical Oncology, Gujarat Cancer and Research Institute, Ahmedabad, Gujarat, India.
| | - Mohit Sharma
- Associate Professor, Department of Surgical Oncology, Gujarat Cancer and Research Institute, Ahmedabad, Gujarat, India.
| | - Dipin Jayaprakash
- Surgical Oncology Resident Doctor, Department of Surgical Oncology, Gujarat Cancer and Research Institute, Ahmedabad, Gujarat, India.
| | - Abhijeet Salunke
- Assistant Professor, Department of Surgical Oncology, Gujarat Cancer and Research Institute, Ahmedabad, Gujarat, India.
| | - Abhishek Jain
- Associate Professor, Department of Surgical Oncology, Gujarat Cancer and Research Institute, Ahmedabad, Gujarat, India.
| | - Shashank Pandya
- Director, Gujarat Cancer and Research Institute, Ahmedabad, Gujarat, India.
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Işık H, İnan MŞ, Kavaklı K, Gürkök S. Reconstruction of large chest wall defects using three-dimensional custom-made implant technology. Turk Gogus Kalp Damar Cerrahisi Derg 2021; 29:122-5. [PMID: 33768992 DOI: 10.5606/tgkdc.dergisi.2021.19385] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/22/2020] [Accepted: 03/11/2020] [Indexed: 11/21/2022]
Abstract
It is a challenging issue for thoracic surgeons to repair and reconstruct large defects after chest wall resection without disturbing pulmonary functions. Currently, it is possible to produce nearly the same prosthesis anatomically as the original with the three-dimensional printer technology. Titanium-alloy prostheses produced with the three-dimensional prototyping technology by selective laser sintering technique meet the sensitive needs of reconstruction without impairing the functionality of the tissue. This custom-made titanium prostheses can be used for this purpose safely and effectively as a good alternative.
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Collaud S, Stork T, Dirksen U, Pöttgen C, Hegedüs B, Schildhaus HU, Bauer S, Aigner C. Surgical Treatment for Primary Chest Wall Sarcoma: A Single-Institution Study. J Surg Res 2020; 260:149-154. [PMID: 33340868 DOI: 10.1016/j.jss.2020.11.078] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2020] [Revised: 11/04/2020] [Accepted: 11/15/2020] [Indexed: 10/22/2022]
Abstract
BACKGROUND Primary sarcomas of the chest wall are rare aggressive tumors. Surgery is part of the multimodal treatment. We describe our institutional patient cohort and evaluate prognostic factors. METHODS All patients who had curative intent surgery for primary chest wall sarcoma from 2004 to 2019 were retrospectively reviewed. Impact on survival-calculated from the date of surgery until last follow-up- was assessed for the following variables: age, gender, type of resection, size, grading, stage, completeness of resection, and neoadjuvant and adjuvant therapy. RESULTS Twenty-three patients (15 males, 65%) with a median age of 54 y (4 to 82) were included. Most common histology was chondrosarcoma (n = 5, 22%). Seven patients (30%) received neoadjuvant and 13 patients (57%) received adjuvant treatment. R0 resection was achieved in 83%. Extended chest wall resection was performed in 14 patients (61%), including lung (n = 13, 57%), diaphragm (n = 2, 9%) and pericardium (n = 1, 4%). Morbidity and 90-day mortality were 23% and 0%, respectively. Three- and 5-year overall survival was 53% and 35%, respectively. R0 resection was predictor of overall survival (P = 0.029). Tumor grade and extended resections were predictors for recurrence (P = 0.034 and P = 0.018, respectively). CONCLUSIONS Surgical resection of primary chest wall sarcoma is a safe procedure even when extended resection is required.
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Affiliation(s)
- Stéphane Collaud
- Department of Thoracic Surgery, Ruhrlandklinik, University of Duisburg-Essen, Essen, Germany; German Cancer Consortium (DKTK), Center Essen, Essen, Germany
| | - Theresa Stork
- Department of Thoracic Surgery, Ruhrlandklinik, University of Duisburg-Essen, Essen, Germany; German Cancer Consortium (DKTK), Center Essen, Essen, Germany
| | - Uta Dirksen
- Department of Pediatrics III, University Hospital Essen, University of Duisburg-Essen, Essen, Germany; German Cancer Consortium (DKTK), Center Essen, Essen, Germany
| | - Christoph Pöttgen
- Department of Radiation Oncology, University Hospital Essen, University of Duisburg-Essen, Essen, Germany; German Cancer Consortium (DKTK), Center Essen, Essen, Germany
| | - Balazs Hegedüs
- Department of Thoracic Surgery, Ruhrlandklinik, University of Duisburg-Essen, Essen, Germany
| | - Hans-Ulrich Schildhaus
- Institute of Pathology, University Hospital Essen, University of Duisburg-Essen, Essen, Germany; German Cancer Consortium (DKTK), Center Essen, Essen, Germany
| | - Sebastian Bauer
- Department of Oncology, University of Duisburg-Essen, Essen, Germany; German Cancer Consortium (DKTK), Center Essen, Essen, Germany
| | - Clemens Aigner
- Department of Thoracic Surgery, Ruhrlandklinik, University of Duisburg-Essen, Essen, Germany; German Cancer Consortium (DKTK), Center Essen, Essen, Germany.
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Wang W, Liang Z, Yang S, Feng Q, Nie X, Su G, Yuan W, Han Y. Three-dimensional (3D)-printed titanium sternum replacement: A case report. Thorac Cancer 2020; 11:3375-3378. [PMID: 33015990 PMCID: PMC7606024 DOI: 10.1111/1759-7714.13655] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2020] [Revised: 08/23/2020] [Accepted: 08/26/2020] [Indexed: 12/02/2022] Open
Abstract
After sternal tumor resection, reconstruction of chest wall defects is still a challenging part of thoracic surgery. Three-dimensional (3D)-printed titanium alloy prosthesis implants provide an effective solution. The bionic bone trabecular micropore structure, which is beneficial to the human body, increases stability and robustness of the prosthesis. Here, we report a successful case of a customized prosthesis using a 3D-printed titanium alloy to repair and reconstruct bone defects in a patient with sternal osteosarcoma who underwent radical resection of the whole sternum.
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Affiliation(s)
| | - Zhaoru Liang
- Yanda Hospital, Hebei Medical UniversitySanheChina
| | - Shiyan Yang
- Yanda Hospital, Hebei Medical UniversitySanheChina
| | - Qing Feng
- Yanda Hospital, Hebei Medical UniversitySanheChina
| | - Xuewei Nie
- Yanda Hospital, Hebei Medical UniversitySanheChina
| | - Guang Su
- Yanda Hospital, Hebei Medical UniversitySanheChina
| | - Wenjie Yuan
- Yanda Hospital, Hebei Medical UniversitySanheChina
| | - Yi Han
- Yanda Hospital, Hebei Medical UniversitySanheChina
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Sakamoto N, Nashimoto M, Nakagawa M, Haruyama Y, Koshida Y, Fukuma E. Skin grafting utilizing a skin of lateral thoracic area for chest wall reconstruction in patient who underwent mastectomy for locally advanced breast cancer. Breast Cancer 2020; 28:533-537. [PMID: 33125672 DOI: 10.1007/s12282-020-01173-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2020] [Accepted: 10/13/2020] [Indexed: 10/23/2022]
Abstract
Locally advanced breast cancer sometimes results in a large chest wall defect at mastectomy. When closing the wound horizontally, the skin tension is usually severe in the middle of the wound, while the skin of the lateral area tends to make a dog-ear deformity. Triangle technique is a procedure to prevent the dog ear in which the skin and subcutaneous fat of the axilla are cut into an equilateral triangle. Herein, we present a case of breast cancer who underwent a mastectomy and closed the wound with a skin graft by utilizing the skin removed from lateral thoracic area using triangle technique. An 85-year-old female visited our institution complaining about the mass on her right breast. Preoperative images showed a 10 cm-sized mass with suspicious axillary and mediastinal lymph nodes swelling. A biopsy revealed a hormone receptor-negative, HER2-positive invasive ductal carcinoma. A mastectomy and axillary lymph node sampling were performed for a local control as the tumor did not respond to four cycles of triweekly trastuzumab combined with S-1. After a transverse elliptical incision, a skin of the lateral thoracic area was harvested using triangle technique. As the middle of the wound had excessive closing tension, the skin was grafted on the defect. After 10 day fixation by a tie-over dressing, the wound healed without complications. This procedure is a simple method for closing a large defect after mastectomy preventing both the dog-ear deformity and a new wound scarring of a donor site.
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Affiliation(s)
- Naomi Sakamoto
- Breast Center, Kameda Medical Center, 929 Higashi-cho, Kamogawa, Chiba, 296-8602, Japan.
| | - Mika Nashimoto
- Breast Center, Kameda Medical Center, 929 Higashi-cho, Kamogawa, Chiba, 296-8602, Japan
| | - Makiko Nakagawa
- Breast Center, Kameda Medical Center, 929 Higashi-cho, Kamogawa, Chiba, 296-8602, Japan
| | - Yurie Haruyama
- Breast Center, Kameda Medical Center, 929 Higashi-cho, Kamogawa, Chiba, 296-8602, Japan
| | - Yoshitomo Koshida
- Breast Center, Kameda Medical Center, 929 Higashi-cho, Kamogawa, Chiba, 296-8602, Japan
| | - Eisuke Fukuma
- Breast Center, Kameda Medical Center, 929 Higashi-cho, Kamogawa, Chiba, 296-8602, Japan
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Joalsen I, Christian D, Rosalie A, Angga M. Reconstruction with titanium mesh following wide excision in chest wall myxofibrosarcoma: A case report. Int J Surg Case Rep 2020; 77:111-115. [PMID: 33160168 PMCID: PMC7649591 DOI: 10.1016/j.ijscr.2020.10.117] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2020] [Revised: 10/24/2020] [Accepted: 10/24/2020] [Indexed: 11/19/2022] Open
Abstract
Extensive resection in chest wall malignancy is mandatory, oftentimes leaving large defects that affect normal respiration. Various materials for chest wall reconstruction are at hand but a definite guideline is not yet available. Titanium meshes provide the suitable strength, rigidity, and flexibility for a chest wall reconstruction material. Titanium mesh is a promising alternative for a chest wall reconstruction material.
Introduction Some chest wall tumors require extensive excision that alters its stability and integrity. Various materials are available as a prosthetic albeit currently lacking in clear guidelines regarding the material of choice. Titanium-based mesh offers appropriate properties for chest wall reconstruction, making it a promising choice of prosthetic. Presentation of case A 50-year-old male presenting with a chest lump was suspected of a chondrosarcoma of the chest wall. Preoperative pulmonary rehabilitation and smoking cessation was performed 1 month prior to surgery. After a wide excision procedure, we utilized titanium mesh as a reconstructive material. Pathology evaluation reported the examined tissue as a myxofibrosarcoma. The patient was successfully weaned off of ventilator in less than 24 h with satisfactory postoperative outcome. Discussion The various available material has each of its strengths and drawbacks and it is crucial to choose the most fitting option to acquire better postoperative outcome as well as maintaining the quality of life. The use of titanium mesh in thoracic reconstruction has not been widely explored and reported, therefore, it is important to underline its advantages and disadvantages as a potential choice for prosthetic. Conclusion Titanium mesh provides appropriate features for a chest wall reconstruction; therefore, it can be considered as a promising alternative material.
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Affiliation(s)
- Ivan Joalsen
- Division of Thoracic, Cardiac and Vascular Surgery, Mulawarman University - Abdul Wahab Sjahranie Hospital Samarinda, East Borneo, Indonesia.
| | - David Christian
- Division of Thoracic, Cardiac and Vascular Surgery, Mulawarman University - Abdul Wahab Sjahranie Hospital Samarinda, East Borneo, Indonesia
| | - Amy Rosalie
- Intern Doctor of Thoracic, Cardiac and Vascular Surgery, Abdul Wahab Sjahranie Hospital Samarinda, East Borneo, Indonesia
| | - Made Angga
- Intern Doctor of Thoracic, Cardiac and Vascular Surgery, Abdul Wahab Sjahranie Hospital Samarinda, East Borneo, Indonesia
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Goldsmith I, Evans PL, Goodrum H, Warbrick-Smith J, Bragg T. Chest wall reconstruction with an anatomically designed 3-D printed titanium ribs and hemi-sternum implant. 3D Print Med 2020; 6:26. [PMID: 32975713 DOI: 10.1186/s41205-020-00079-0] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [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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Wang L, Liu X, Jiang T, Huang L. Three-dimensional printed polyether-ether-ketone implant for extensive chest wall reconstruction: A case report. Thorac Cancer 2020; 11:2709-2712. [PMID: 32677759 PMCID: PMC7471033 DOI: 10.1111/1759-7714.13560] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2020] [Revised: 06/08/2020] [Accepted: 06/15/2020] [Indexed: 12/01/2022] Open
Abstract
Three-dimensional printed (3DP) implant offers a valid option with perfect anatomic fitting in individual and skeletal reconstruction of the chest wall. Herein, we present the case of a patient with a large chest wall tumor, where an extensive chest wall defect was repaired using 3DP polyether-ether-ketone (PEEK) implants. Surgical treatment planning was performed according to the computed tomography (CT) images in DICOM format. A 3DP implant was then design and fabricated. A wide excision of the chest wall tumor was performed, including the entire sternum, 2-6 costal cartilage and ribs, and parietal pleura. Furthermore, a skeletal reconstruction was carried out using a 3DP PEEK implant. The patient recovered well without surgical complications or tumor recurrence in the following year. In general, 3DP PEEK implant is an appropriate alternative for chest wall reconstruction. KEY POINTS: SIGNIFICANT FINDINGS OF THE STUDY: Skeletal reconstruction after wide excision of the chest wall remains a challenging problem for clinicians. WHAT THIS STUDY ADDS: 3DP PEEK implant is an appropriate alternative for chest wall reconstruction.
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Affiliation(s)
- Lei Wang
- Department of Thoracic Surgery, Tangdu Hospital, The Fourth Military Medical University, Xi'an, China
| | - Xi Liu
- Department of Thoracic Surgery, Tangdu Hospital, The Fourth Military Medical University, Xi'an, China
| | - Tao Jiang
- Department of Thoracic Surgery, Tangdu Hospital, The Fourth Military Medical University, Xi'an, China
| | - Lijun Huang
- Department of Thoracic Surgery, Tangdu Hospital, The Fourth Military Medical University, Xi'an, China
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Tamburrini A, Ahmed H, Talbot T, Harrison O, Khan M, Tilley S, Alzetani A. Delayed post-traumatic presentation of severe sternal osteomyelitis: A strong multidisciplinary effort and a novel reconstruction technique for a challenging case. Trauma Case Rep 2020; 27:100305. [PMID: 32455160 PMCID: PMC7236049 DOI: 10.1016/j.tcr.2020.100305] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/03/2020] [Indexed: 11/30/2022] Open
Abstract
Sternal osteomyelitis is a morbid and challenging condition, which can rarely occur after trauma, with no established consensus over best therapeutic options. In this case, a 47-year-old man with history of intravenous drug use presented 11 weeks after a minor blunt chest trauma with a severe necrotizing osteomyelitis involving sternum, muscles, fascia and subcutaneous tissue and positive blood cultures for Methicillin Sensitive Staphylococcus aureus. Alongside tailored antibiotic therapy, extensive surgical debridement was performed, leaving a full thickness 3 × 4 cm sternal defect and a large skin defect. After 4 weeks of antibiotics and Vacuum-Assisted-Closure pump, a novel reconstruction technique was utilized, with full collaborations of thoracic surgeons, orthopaedic surgeons and plastic surgeons. An autologous tricortical iliac crest bone graft was harvested and shaped to fit the full-thickness sternal defect, while two titanium sigmoid-shaped clavicle plates were used for internal fixation of the autograft. The large skin defect was covered with a pedicled myocutaneous latissimus dorsi flap. Integrity and stability of the chest wall was fully restored, and infection was completely eradicated. No complications occurred and the patient was well at the 18 months follow-up. To the best of our knowledge, this is the first report on autologous iliac crest bone graft in the treatment of sternal osteomyelitis. In this case, it proved to be a viable therapeutic option, providing good long-term clinical and cosmetic results.
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Affiliation(s)
| | - Hanad Ahmed
- Medical School, Southampton University Hospital, UK
| | - Thomas Talbot
- Thoracic Surgery Unit, Southampton University Hospital, UK
| | | | - Mansoor Khan
- Plastic and Reconstructive Surgery Unit, Southampton University Hospital, UK
| | - Simon Tilley
- Trauma and Orthopaedic Unit, Southampton University Hospital, UK
| | - Aiman Alzetani
- Thoracic Surgery Unit, Southampton University Hospital, UK
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Elfering L, van de Grift TC, Bouman MB, van Mello NM, Groenman FA, Huirne JA, Budiman IYW, Goijen LDJ, van Loenen DKG, Mullender MG. Combining total laparoscopic hysterectomy and bilateral salpingo-oophorectomy with subcutaneous mastectomy in trans men: The effect on safety outcomes. Int J Transgend Health 2020; 21:138-146. [PMID: 33015665 PMCID: PMC7430461 DOI: 10.1080/26895269.2020.1751014] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
Background: Masculinizing mastectomy is the most requested gender affirming surgery (GAS) in trans men, followed by genital GAS. Mastectomy and total laparoscopic hysterectomy, with or without bilateral salpingo-oophorectomy (TLH ± BSO), can both be performed in one single operation session. However, data on complication rates of the combined procedure is scarce and no consensus exists on the preferred order of procedures. Aims: To compare safety outcomes between mastectomy performed in a single procedure with those when performed in a combined procedure and assess whether the order of procedures matters when they are combined. Methods: A retrospective chart review was performed of trans men who underwent masculinizing mastectomy with or without TLH ± BSO in a combined session. The effects of the surgical procedure on complication and reoperation rate of the chest were assessed using logistic regression. Results: In total, 480 trans men were included in the study. Of these, 212 patients underwent the combined procedure. The gynecological procedure was performed first in 152 (71.7%) patients. In the total sample, postoperative hematoma of the chest occurred in 11.3%; 16% in the combined versus 7.5% in the single mastectomy group (p = 0.001). Reoperations due to hematoma of the chest were performed in 7.5% of all patients; 10.8% in the combined versus 4.9% in the single mastectomy group (p = 0.017). The order of procedures in the combined group had no significant effect on postoperative hematoma of the chest (p = 0.856), and reoperations (p = 0.689). Conclusion: Combining masculinizing mastectomy with TLH ± BSO in one session was associated with significantly more hematoma and reoperations compared with separately performing mastectomy. This increased risk of complications after a combined procedure should be considered when deciding on surgical options. The order of procedures in a combined procedure did not have an effect on safety outcomes.
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Affiliation(s)
- Lian Elfering
- Department of Plastic Reconstructive and Hand Surgery, Amsterdam UMC, Amsterdam, The Netherlands
- Amsterdam Public Health Research Institute, Amsterdam UMC, Amsterdam, The Netherlands
| | - Tim C. van de Grift
- Department of Plastic Reconstructive and Hand Surgery, Amsterdam UMC, Amsterdam, The Netherlands
- Amsterdam Public Health Research Institute, Amsterdam UMC, Amsterdam, The Netherlands
- Department of Medical Psychology, Center of Expertise on Gender Dysphoria, Amsterdam UMC, Amsterdam, The Netherlands
| | - Mark-Bram Bouman
- Department of Plastic Reconstructive and Hand Surgery, Amsterdam UMC, Amsterdam, The Netherlands
- Amsterdam Public Health Research Institute, Amsterdam UMC, Amsterdam, The Netherlands
| | - Norah M. van Mello
- Department of Obstetrics and Gynecology, Amsterdam UMC, Amsterdam, The Netherlands
| | - Freek A. Groenman
- Department of Obstetrics and Gynecology, Amsterdam UMC, Amsterdam, The Netherlands
| | - Judith A. Huirne
- Department of Obstetrics and Gynecology, Amsterdam UMC, Amsterdam, The Netherlands
| | - Ivo Y. W. Budiman
- Department of Plastic Reconstructive and Hand Surgery, Amsterdam UMC, Amsterdam, The Netherlands
| | - Linde D. J. Goijen
- Department of Plastic Reconstructive and Hand Surgery, Amsterdam UMC, Amsterdam, The Netherlands
| | | | - Margriet G. Mullender
- Department of Plastic Reconstructive and Hand Surgery, Amsterdam UMC, Amsterdam, The Netherlands
- Amsterdam Public Health Research Institute, Amsterdam UMC, Amsterdam, The Netherlands
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Jacob S, Pooley RA, Thomas M. Three-Dimensional-Printed Model as a Template for Chest Wall Reconstruction. Heart Lung Circ 2020; 29:1566-1570. [PMID: 32280015 DOI: 10.1016/j.hlc.2020.02.004] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2019] [Revised: 01/14/2020] [Accepted: 02/20/2020] [Indexed: 10/24/2022]
Abstract
BACKGROUND To our knowledge, this is the first time that a three-dimensional (3D)-printed model was used as an intraoperative template to recreate the resected portion of the lateral chest wall after resection of a large chest-wall tumour. METHODS Fabrication of 3D-printed models requires collaboration among a surgeon, radiologist, segmenter, and 3D printing centre. Three-dimensional models are created with computed tomographic and magnetic resonance data. These models can provide an accurate guide for surgical resection and can be used intraoperatively as a template to construct tailored prostheses. RESULTS We achieved complete resection of the chest wall defect, restored skeletal function and physiologic chest excursion, and achieved the best cosmetic appearance in all cases. CONCLUSIONS Small- to medium-sized chest wall defects can be repaired with musculocutaneous flaps with or without prosthetic materials, but more complicated defects require increasingly sophisticated reconstructive techniques and technologies. An advanced technique is the use of a 3D-printed model of the chest wall as an intraoperative template.
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Affiliation(s)
- Samuel Jacob
- Department of Cardiothoracic Surgery, Mayo Clinic, Jacksonville, FL, USA.
| | | | - Mathew Thomas
- Department of Cardiothoracic Surgery, Mayo Clinic, Jacksonville, FL, USA
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Wald O, Islam I, Amit K, Ehud R, Eldad E, Omer O, Aviad Z, Moshe SO, Uzi I. 11-year experience with Chest Wall resection and reconstruction for primary Chest Wall sarcomas. J Cardiothorac Surg 2020; 15:29. [PMID: 31992336 PMCID: PMC6988268 DOI: 10.1186/s13019-020-1064-y] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2019] [Accepted: 01/03/2020] [Indexed: 11/26/2022] Open
Abstract
Background & Objectives Primary chest wall sarcomas are rare and therapeutically challenging tumors. Herein we report the outcomes of a surgery-based multimodality therapy for these pathologies over an 11-year period. In addition, we present a case that illustrates the surgical challenges that extensive chest wall resection may pose. Methods Using the Society of Thoracic Surgeons general thoracic surgery database, we have prospectively collected data in our institute on all patients undergoing chest wall resection and reconstruction for primary chest wall sarcomas between June 2008–October 2019. Results We performed 28 surgical procedures on 25 patients aged 5 to 91 years (median age 33). Eleven tumors were bone- and cartilage-derived and 14 tumors originated from soft tissue elements. Seven patients (7/25, 28%) received neo-adjuvant therapy and 14 patients (14/25, 56%) received adjuvant therapy. The median number of ribs that were resected was 2.5 (range 0 to 6). In 18/28 (64%) of surgeries, additional skeletal or visceral organs were removed, including: diaphragm [1], scapula [2], sternum [2], lung [2], vertebra [1], clavicle [1] and colon [1]. Chest wall reconstruction was deemed necessary in 16/28 (57%) of cases, polytetrafluoroethylene (PTFE) Gore-Tex patches was used in 13/28 (46%) of cases and biological flaps where used in 4/28 (14%) of cases. R0, R1 and R2 resection margins were achieved in 19/28 (68%), 9/28 (32%) and 0/28 (0%) of cases, respectively. The median follow up time was 33 months (range 2 to 138). During the study period, disease recurred in 8/25 (32%) of patients. Of these, 3 were re-operated on and are free of disease. At date of last follow up, 5/25 (20%) of patients have died due to their disease and in contrast, 20/25 (80%) were alive with no evidence of disease. Conclusions Surgery-based multimodality therapy is an effective treatment approach for primary chest wall sarcomas. Resection of additional skeletal or visceral organs and reconstruction with synthetic and/or biological flaps is often required in order to obtain R0 resection margins. Ultimately, long-term survival in this clinical scenario is an achievable goal.
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Affiliation(s)
- Ori Wald
- Department of Cardiothoracic Surgery, Hadassah Hebrew University Hospital, Jerusalem, Israel.
| | - Idais Islam
- Department of Cardiothoracic Surgery, Hadassah Hebrew University Hospital, Jerusalem, Israel
| | - Korach Amit
- Department of Cardiothoracic Surgery, Hadassah Hebrew University Hospital, Jerusalem, Israel
| | - Rudis Ehud
- Department of Cardiothoracic Surgery, Hadassah Hebrew University Hospital, Jerusalem, Israel
| | - Erez Eldad
- Department of Cardiothoracic Surgery, Hadassah Hebrew University Hospital, Jerusalem, Israel
| | - Or Omer
- Department of Orthopedics, Hadassah Hebrew University Hospital, Jerusalem, Israel
| | - Zik Aviad
- Department of Oncology, Hadassah Hebrew University Hospital, Jerusalem, Israel
| | - Shapira Oz Moshe
- Department of Cardiothoracic Surgery, Hadassah Hebrew University Hospital, Jerusalem, Israel
| | - Izhar Uzi
- Department of Cardiothoracic Surgery, Hadassah Hebrew University Hospital, Jerusalem, Israel.
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Menon A, Khalil H, Naidu B, Bishay E, Steyn R, Kalkat MS. Chest wall resection and reconstruction for recurrent breast cancer - A multidisciplinary approach. Surgeon 2020; 18:208-213. [PMID: 31917085 DOI: 10.1016/j.surge.2019.10.001] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2019] [Revised: 10/01/2019] [Accepted: 10/02/2019] [Indexed: 11/16/2022]
Abstract
BACKGROUND Despite therapeutic advances in the management of breast cancer, a significant number of patients present with locoregional recurrence. Treatment with hormonal, chemo or radiotherapy remains standard in such cases. However, in selected patients of recurrent breast cancer involving chest wall, multidisciplinary surgical approach could be considered. METHODS Between 2010 and 2018, 21 patients with recurrent breast cancer, involving chest wall, were treated at a tertiary care center with resection and reconstruction. The mean age of the patients was 55 years (22-77 years). RESULTS The median interval from first breast resection to chest wall resection (CWR) for recurrent disease was 6 years (1-24 years). Eighteen patients underwent bony resection and 3 patients required extensive soft tissue resection. Complete resection was achieved in 90% of patients. All patients had chest wall reconstruction. There was no in-hospital mortality. During follow-up, 8 patients died, of which 7 were due to distant metastases. The 1 year and 3-year overall survival were 90% (95% CI 66-97) and 61% (95% CI 31-81) respectively. The disease-free survival at 1 and 3 years was the same at 70% (95% CI 45-86). At a mean follow up of 23 months, the average survival in patients operated for local recurrence is 51.7 months (95% CI 37.7-65.7) and 24.5 months (95% CI 7.3-41.7) for patients with distant metastatic recurrence. CONCLUSION A multidisciplinary oncoplastic approach for recurrent breast cancer, which includes chest wall resection and reconstruction is a useful adjunct in selected group of patients. This improves local disease control, symptoms and possibly disease-free survival.
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Affiliation(s)
- Ashvini Menon
- Department of Thoracic Surgery, Birmingham Heartlands Hospital, University Hospitals Birmingham Trust, Bordesley Green East, Birmingham, UK
| | - Haitham Khalil
- Plastic and Reconstructive Surgery Division, Good Hope Hospital, Sutton Coldfield, Birmingham, West Midlands, UK
| | - Babu Naidu
- Department of Thoracic Surgery, Birmingham Heartlands Hospital, University Hospitals Birmingham Trust, Bordesley Green East, Birmingham, UK
| | - Ehab Bishay
- Department of Thoracic Surgery, Birmingham Heartlands Hospital, University Hospitals Birmingham Trust, Bordesley Green East, Birmingham, UK
| | - Richard Steyn
- Department of Thoracic Surgery, Birmingham Heartlands Hospital, University Hospitals Birmingham Trust, Bordesley Green East, Birmingham, UK
| | - Maninder S Kalkat
- Department of Thoracic Surgery, Birmingham Heartlands Hospital, University Hospitals Birmingham Trust, Bordesley Green East, Birmingham, UK.
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Aladaileh M, O’Driscoll-Collins A, O’Keeffe F, Conneely JB, Redmond K. Traumatic thoracoabdominal hernia repair using a novel chest-wall reconstruction technique: a case report. Ann R Coll Surg Engl 2020; 102:e4-e6. [PMID: 31509003 PMCID: PMC6937607 DOI: 10.1308/rcsann.2019.0120] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/30/2019] [Indexed: 11/22/2022] Open
Abstract
Thoracoabdominal hernia following blunt trauma is extremely rare. Abdominal viscera are more likely to herniate into the thorax if there is traumatic diaphragmatic rupture. We report the case of a patient presenting with a traumatic thoracoabdominal hernia containing part of the right lobe of the liver and the hepatic flexure of the colon. The hernia migrated cranially, to protrude through a seventh intercostal defect despite the diaphragm remaining fully intact. The need for early multispecialty (thoracic and hepatobiliary) surgical repair is highlighted, with improvements in surgical outcome for a complex trauma case by using a novel chest-wall reconstruction technique.
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Affiliation(s)
- M Aladaileh
- Department of Thoracic Surgery, Mater Misericordiae University Hospital, Dublin, Ireland
| | - A O’Driscoll-Collins
- Department of Thoracic Surgery, Mater Misericordiae University Hospital, Dublin, Ireland
| | - F O’Keeffe
- Emergency Department, Mater Misericordiae University Hospital, Dublin, Ireland
| | - JB Conneely
- Department of Hepatobiliary Surgery, Mater Misericordiae University Hospital, Dublin, Ireland
| | - K Redmond
- Department of Thoracic Surgery, Mater Misericordiae University Hospital, Dublin, Ireland
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Abstract
BACKGROUND Composite chest wall reconstruction, following the assurance of chest wall stability, often requires well-vascularized soft tissue coverage with flaps to insure adequate wound healing. Unfortunately, prior surgical approaches such as the posterolateral thoractomy incision or extensive wound breakdown may impede the availability of local or regional choices. A free flap would then be a reasonable option, but in the unstable patient a new donor site is unreasonable. Instead, the otherwise inadequate muscle remnants often transected by the usual thoracotomy incision can be extended by microvascular grafts to provide the necessary reach to the defect. METHOD The ipsilateral cephalic latissimus dorsi and/or serratus anterior muscle remnants following their transection by a posterolateral thoractomy incision can be simultaneously raised as a chimeric flap pedicled in common by the thoracodorsal vessels. The distance the pedicle must be extended to reach the defect requiring coverage is measured, and a vascular graft from the descending branch of the lateral circumflex femoral vessels of the same length is harvested. The thoracodorsal vessels are divided, the vascular graft inserted and anastomosed end-to-end to the cut ends of the former, and then the flap can be stretched the required distance for insetting. RESULT A case example of use of the ipsilateral latissimus dorsi-serratus anterior muscle remnants used after extension with arterial and venous grafts to the thoracodorsal vessels as the recipient site is presented with successful salvage of a life-threatening posteriolateral thoractomy wound dehiscence. CONCLUSION Transection of muscles from a posterolateral thoracotomy incision does not preclude their use as flaps in extenuating circumstances. Their pedicle can be extended using vascular grafts and microvascular techniques in a sense to create a local free flap to provide another solution to a challenging problem.
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Affiliation(s)
- Geoffrey G Hallock
- Division of Plastic Surgery, Sacred Heart Hospital, Allentown, Pennsylvania, St. Luke's Hospital, 1230 S. Cedar Crest Blvd., Suite 306, Allentown, Bethlehem, PA, United States.
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Abstract
The optimal surgical reconstruction of chest wall defects especially in the context of posttraumatic, oncological and congenital etiologies has a large impact on the recovery of the patients. Regardless of the etiology, various complications, such as a generally impaired respiratory physiology in an unstable thorax or decreased pulmonary clearance associated with acute and chronic pulmonary infections, may impair the recovery of affected patients. The postoperative occurrence of an intrathoracic dead space may lead to a difficult to treat empyema. Each thoracic wall defect must be accurately assessed and treated according to size, depth and location on the chest. The complexity of this condition and the resulting complications require the highest degree of surgical care which should be interdisciplinary both preoperatively and postoperatively.
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Affiliation(s)
- M Heldwein
- Klinik für Herz und Thoraxchirurgie, Uniklinik Köln, Universität zu Köln, Kerpener Str. 62, 50937, Köln, Deutschland
| | - F Doerr
- Klinik für Herz und Thoraxchirurgie, Uniklinik Köln, Universität zu Köln, Kerpener Str. 62, 50937, Köln, Deutschland
| | - G Schlachtenberger
- Klinik für Herz und Thoraxchirurgie, Uniklinik Köln, Universität zu Köln, Kerpener Str. 62, 50937, Köln, Deutschland
| | - K Hekmat
- Klinik für Herz und Thoraxchirurgie, Uniklinik Köln, Universität zu Köln, Kerpener Str. 62, 50937, Köln, Deutschland.
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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] [What about the content of this article? (0)] [Affiliation(s)] [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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Malathi L, Das S, Nair JTK, Rajappan A. Chest wall reconstruction: success of a team approach-a 12-year experience from a tertiary care institution. Indian J Thorac Cardiovasc Surg 2019; 36:44-51. [PMID: 33061093 DOI: 10.1007/s12055-019-00841-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2019] [Revised: 05/16/2019] [Accepted: 05/24/2019] [Indexed: 10/26/2022] Open
Abstract
Background The thoracic cavity was considered as a forbidden area in the past and anyone attempting to meddle with it was expected to be doomed. But the past several decades have seen a marked improvement in the management and reconstruction of complex chest wall defects. This study was undertaken to review our experience in chest wall reconstruction during the past 12 years and to stress upon the importance of a multidisciplinary team approach to this complex problem. Methods After obtaining the necessary clearance from institutional ethics committee, we did a retrospective review of all case records of chest wall reconstructions (CWR) performed in our institution during a 12-year period from May 2005 to September 2016. Patient characteristics, co-morbidities, operative data and post-operative complications and outcomes were reviewed. Results During the study period, a total of 32 patients underwent CWR. All patients were assessed, planned, operated and managed by a team consisting of thoracic surgeons, plastic surgeons, intensivists and pulmonologists. Patients were in the age group of 14-72 with a male:female ratio of 15:17. Indications for CWR were neoplasms (n = 13-40.62%), post-sternotomy wound dehiscence (n = 12-37.5%), osteoradionecrosis (n = 4-12.5%), tuberculosis (n = 2-6.25%) and osteomyelitis rib (1/32-3.125%). Inflammatory defects were mostly closed with soft tissue alone whereas skeletal stabilisation with soft tissue cover was required in tumour resections. All were pedicled flaps, the most common being pectoralis major (PM) muscle flap (n = 12). Others include latissimus dorsi (LD) muscle (n = 9); rectus abdominis (RA) muscle (n = 2); transverse rectus abdominis musculocutaneous flap (TRAM) (n = 2), deltopectoral (DP) (n = 1), omentum (n = 3) and breast flap (n = 3). Post-operative complications include wound dehiscence (12%), wound infection (21%) and recurrent sinus formation (7%). One partial flap failure was recorded. Post-operative mortality was 3%. Conclusion Chest wall reconstruction is a complex procedure and each defect needs an individualised approach for optimum outcome. Extensive chest wall resections can be safely undertaken with the support of the reconstructive surgeon and with good critical care back up.
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Affiliation(s)
- Lekshmi Malathi
- Department of Plastic Surgery, Government Medical College Kottayam, Kottayam, Kerala India
| | - Sankar Das
- Department of Plastic Surgery, Government Medical College Kottayam, Kottayam, Kerala India
| | | | - Aniraj Rajappan
- Department of Plastic Surgery, Government Medical College Kottayam, Kottayam, Kerala India
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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] [What about the content of this article? (0)] [Affiliation(s)] [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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Tozum H, Aydemir AN, Demiroglu M, Ozkan K, Ceyran AB, Kılıc B. A rare rib lesion due to parosteal osteosarcoma: a case report. J Med Case Rep 2019; 13:19. [PMID: 30670083 DOI: 10.1186/s13256-018-1958-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2017] [Accepted: 12/18/2018] [Indexed: 11/10/2022] Open
Abstract
Introduction Masses which develop on the surface of the rib bones are rare. The differential diagnosis includes benign and malignant lesions. Case presentation A 23-year-old European woman presented at an out-patient clinic with a 9-month history of a painless swelling on the right posterolateral side of her chest wall. The case reported here is of a very rarely seen parosteal osteosarcoma of the rib that was treated with wide resection and chest wall reconstruction. There was no evidence of local recurrence or distal metastasis after a 1-year follow-up. Conclusion Parosteal osteosarcoma is a locally aggressive malignant tumor, and resection with a wide margin is the most appropriate treatment. Correct diagnosis of parosteal osteosarcoma is challenging for an orthopedic surgeon. Although rare, in the differential diagnosis of lesions located on the ribs, parosteal osteosarcoma should be considered and a systematic diagnostic approach should be taken.
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Kress RL, Dalwadi SM, Irani AD. R0 resection and reconstruction for a large, rapidly progressive chest wall sarcoma. J Cardiothorac Surg 2018; 13:127. [PMID: 30558620 PMCID: PMC6296059 DOI: 10.1186/s13019-018-0812-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2018] [Accepted: 12/03/2018] [Indexed: 01/03/2023] Open
Abstract
Background Chest wall sarcomas are a rare group of soft tissue malignancies with variable presentations. Here we describe the definitive management of a large, rapidly progressing chest wall sarcoma arising from the pectoralis major muscle. Case report An obese 42-year-old African American male with multiple medical comorbidities presented with new onset right-sided chest pain and a palpable right chest mass. Initial CT chest demonstrated a 9x9x9cm necrotic mass arising from the pectoralis major. CT-guided core biopsy was positive for high-grade spindle cell neoplasm (positive for smooth muscle actin, desmin, S100, and CD31; negative for CD34, PAX8, and beta-catenin). Staging imaging 2 months later demonstrated growth of the mass to 21.4 × 17.8 × 13.7 cm. The patient underwent neoadjuvant chemoradiation with surveillance CT imaging demonstrating a stable tumor. Then he underwent wide local excision of the mass followed by delayed local myocutaneous flap reconstruction and skin grafting. Final pathology was R0 resection, 38x20x18 cm tumor with 70% gross necrosis. Microscopic examination confirmed high-grade sarcoma with smooth muscle differentiation. Final pathologic staging was Stage III G3 pT2bNxMx. Conclusions This patient presented with a rare, rapidly enlarging high-grade leiomyosarcoma of the chest wall without metastases or violation of the thorax. We describe the definitive management including a multidisciplinary team to manage a complex and rapidly progressive sarcoma of the chest wall.
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Affiliation(s)
- Robert L Kress
- Department of Surgery, UT Health at McGovern Medical School, 6431 Fannin St, Houston, TX, 77030, USA.
| | - Shraddha M Dalwadi
- Department of Surgery, UT Health at McGovern Medical School, 6431 Fannin St, Houston, TX, 77030, USA
| | - Adel D Irani
- Department of Cardiothoracic And Vascular Surgery, UT Health at McGovern Medical School, Houston, USA
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Zhong D, Wang L, Li X, Huang L. [Research Status of the Skeletalre Construction of Chest Wall]. Zhongguo Fei Ai Za Zhi 2018; 21:273-276. [PMID: 29587904 PMCID: PMC5973342 DOI: 10.3779/j.issn.1009-3419.2018.04.07] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
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。
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Affiliation(s)
- Daixing Zhong
- Department of Thoracic Surgery, Tangdu Hospital, Fourth Military Medical University, Xi'an 710038, China
| | - Lei Wang
- Department of Thoracic Surgery, Tangdu Hospital, Fourth Military Medical University, Xi'an 710038, China
| | - Xiaofei Li
- Department of Thoracic Surgery, Tangdu Hospital, Fourth Military Medical University, Xi'an 710038, China
| | - Lijun Huang
- Department of Thoracic Surgery, Tangdu Hospital, Fourth Military Medical University, Xi'an 710038, China
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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] [What about the content of this article? (0)] [Affiliation(s)] [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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Abstract
Pediatric chest wall tumors are rare. Malignancies predominate of which sarcomas are the most common. Their resection and the subsequent reconstruction of the chest wall has been a surgical challenge since Dr. Frederick W. Parham published his first comprehensive account on the subject in 1898. Chest wall reconstruction is age, site and pathology dependent, must preserve long term function and cosmesis, must accommodate future growth and development, and must not be a hindrance to adjuvant radiotherapy. Bony reconstruction can be relatively simple or complex involving combinations of synthetic meshes, bioprosthetic materials, steel or titanium constructs, autografts, homografts and porcine or bovine xenografts. Soft tissue coverage can be achieved with direct closure, skin grafts, local advancement flaps, pedicled or free myocutaneous or osseomyocutaneous flaps or a combination of these. Complications to be avoided include scoliosis, pain and activity restriction, restrictive pulmonary deficits and interference with adjuvant radiotherapy which may result in tumor recurrence. Advances in cancer therapy have improved short- and long-term survival but significant functional and cosmetic challenges remain particularly for large chest wall defects in the very young. The future may lie with absorbable semi-rigid meshes, biointegratable acellular homografts and xenografts, demineralized bone matrices and bone marrow stromal cells, the patient's own lab-grown stem-cell based vascularized osseomyocutaneous chest wall grafts or the obsolescence of surgical resection altogether in the age of targeted anti-tumor and immune based therapy.
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Affiliation(s)
- Gideon Sandler
- Pediatric Surgical Oncology, The University of Texas MD Anderson Cancer Center, 1400 Pressler Street 17.6053, External Mail: Unit 1484, Houston, TX 77030, United States of America.
| | - Andrea Hayes-Jordan
- Pediatric Surgical Oncology, The University of Texas MD Anderson Cancer Center, 1400 Pressler Street 17.6053, External Mail: Unit 1484, Houston, TX 77030, United States of America.
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