1
|
Liu C, Sun H, Lin F. The application of three-dimensional custom-made prostheses in chest wall reconstruction after oncologic sternal resection. J Surg Oncol 2024; 129:1063-1072. [PMID: 38311813 DOI: 10.1002/jso.27597] [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: 07/18/2023] [Revised: 12/19/2023] [Accepted: 01/19/2024] [Indexed: 02/06/2024]
Abstract
BACKGROUND AND OBJECTIVES As one of the cutting-edge advances in the field of reconstruction, three-dimensional (3D) printing technology has been constantly being attempted to assist in the reconstruction of complicated large chest wall defects. However, there is little literature assessing the treatment outcomes of 3D printed prostheses for chest wall reconstruction. This study aimed to analyze the surgical outcomes of 3D custom-made prostheses for the reconstruction of oncologic sternal defects and to share our experience in the surgical management of these rare and complex cases. METHODS We summarized the clinical features of the sternal tumor in our center, described the surgical techniques of the application of 3D customized prosthesis for chest wall reconstruction, and analyzed the perioperative characteristics, complications, overall survival (OS), and recurrence-free survival of patients. RESULTS Thirty-two patients with the sternal tumor who underwent chest wall resection were identified, among which 13 patients used 3D custom-made titanium implants and 13 patients used titanium mesh for sternal reconstruction. 22 cases were malignant, and chondrosarcoma is the most common type. The mean age was 46.9 years, and 53% (17/32) of the patients were male. The average size of tumor was 6.4 cm, and the mean defect area was 76.4 cm2. 97% (31/32) patients received R0 resection. Complications were observed in 29% (9/32) of patients, of which wound infection (22%, 7/32) was the most common. The OS of the patients was 72% at 5 years. CONCLUSION We demonstrated that with careful preoperative assessment, 3D customized prostheses could be a viable alternative for complex sternal reconstruction.
Collapse
Affiliation(s)
- Chengxin Liu
- Department of Thoracic Surgery, West China Hospital, Sichuan University, Chengdu, China
| | - Haipeng Sun
- Department of Thoracic Surgery, West China Hospital, Sichuan University, Chengdu, China
| | - Feng Lin
- Department of Thoracic Surgery, West China Hospital, Sichuan University, Chengdu, China
| |
Collapse
|
2
|
Shillinglaw JP, Nonnemacher CJ, Christie DB. Large Penetrating Wounds to the Chest Managed With Immediate Chest Wall Reconstruction Using Biologic Mesh, Titanium Plates, and Rotational Tissue Flaps. Am Surg 2024:31348241244649. [PMID: 38596898 DOI: 10.1177/00031348241244649] [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] [Indexed: 04/11/2024]
Abstract
Large open chest wall wounds can be difficult to manage due to full-thickness tissue loss with underlying rib fractures and exposed lung parenchyma. Historically, the use of synthetic material has been discouraged in the traumatic setting with the concern that it may be associated with an increased risk of infection. We present 4 patients with large open injuries to the thorax-one from blunt and three from penetrating trauma. We describe our initial management followed by prompt surgical repair using biologic mesh, titanium rib spanning plates, and rotational tissue flaps with Z-plasty of the skin for definite closure. All patients did well post-operatively without complications or wound infections. With the appropriate management, we suspect there may be an advantage in performing immediate reconstruction and closure in large open thoracic injuries utilizing biologic mesh and titanium rib spanning plates with a lower risk of infection than previously believed.
Collapse
Affiliation(s)
- John P Shillinglaw
- Department of General Surgery and Trauma, Medical Center Atrium Health, Macon, GA, USA
| | - Cory J Nonnemacher
- Department of General Surgery and Trauma, Medical Center Atrium Health, Macon, GA, USA
| | - Dudley B Christie
- Department of General Surgery and Trauma, Medical Center Atrium Health, Macon, GA, USA
| |
Collapse
|
3
|
Sarvan M, Etienne H, Bankel L, Brown ML, Schneiter D, Opitz I. Outcome Analysis of Treatment Modalities for Thoracic Sarcomas. Cancers (Basel) 2023; 15:5154. [PMID: 37958328 PMCID: PMC10649966 DOI: 10.3390/cancers15215154] [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: 09/30/2023] [Revised: 10/22/2023] [Accepted: 10/24/2023] [Indexed: 11/15/2023] Open
Abstract
BACKGROUND Primary chest wall sarcomas are a rare and heterogeneous group of chest wall tumors that require multimodal oncologic and surgical therapy. The aim of this study was to review our experience regarding the surgical treatment of chest wall sarcomas, evaluating the short- and long-term results. METHODS In this retrospective single-center study, patients who underwent surgery for soft tissue and bone sarcoma of the chest wall between 1999 and 2018 were included. We analyzed the oncologic and surgical outcomes of chest wall resections and reconstructions, assessing overall and recurrence-free survival and the associated clinical factors. RESULTS In total, 44 patients underwent chest wall resection for primary chest wall sarcoma, of which 18 (41%) received surgery only, 10 (23%) received additional chemoradiotherapy, 7% (3) received surgery with chemotherapy, and 30% (13) received radiotherapy in addition to surgery. No perioperative mortality occurred. Five-year overall survival was 51.5% (CI 95%: 36.1-73.4%), and median overall survival was 1973 days (CI 95% 1461; -). As determined in the univariate analysis, the presence of metastasis upon admission and tumor grade were significantly associated with shorter survival (p = 0.037 and p < 0.01, respectively). Five-year recurrence-free survival was 71.5% (95% CI 57.6%; 88.7%). Tumor resection margins and metastatic disease upon diagnosis were significantly associated with recurrence-free survival (p < 0.01 and p < 0.01, respectively). CONCLUSION Surgical therapy is the cornerstone of the treatment of chest wall sarcomas and can be performed safely. Metastasis and high tumor grade have a negative influence on overall survival, while tumor margins and metastasis have a negative influence on local recurrence.
Collapse
Affiliation(s)
- Milos Sarvan
- Department of Plastic Surgery and Hand Surgery, University Hospital Zurich, 8091 Zurich, Switzerland;
| | - Harry Etienne
- Department of Thoracic Surgery, University Hospital Zurich, 8091 Zurich, Switzerland; (H.E.); (D.S.)
| | - Lorenz Bankel
- Department of Medical Oncology, University Hospital Zurich, 8091 Zurich, Switzerland;
| | - Michelle L. Brown
- Department of Radiation Oncology, University Hospital Zurich, 8091 Zurich, Switzerland;
| | - Didier Schneiter
- Department of Thoracic Surgery, University Hospital Zurich, 8091 Zurich, Switzerland; (H.E.); (D.S.)
| | - Isabelle Opitz
- Department of Thoracic Surgery, University Hospital Zurich, 8091 Zurich, Switzerland; (H.E.); (D.S.)
| |
Collapse
|
4
|
Vanstraelen S, Ali B, Bains MS, Shahzad F, Allen RJ, Matros E, Dycoco J, Adusumilli PS, Bott MJ, Downey RJ, Huang J, Isbell JM, Molena D, Park BJ, Rusch VW, Sihag S, Cordeiro PG, Coriddi MR, Dayan JH, Disa J, McCarthy CM, Nelson JA, Stern C, Mehrara B, Jones DR, Rocco G. The contribution of microvascular free flaps and pedicled flaps to successful chest wall surgery. J Thorac Cardiovasc Surg 2023; 166:1262-1272.e2. [PMID: 37236598 PMCID: PMC10528168 DOI: 10.1016/j.jtcvs.2023.05.018] [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: 03/13/2023] [Revised: 04/25/2023] [Accepted: 05/09/2023] [Indexed: 05/28/2023]
Abstract
OBJECTIVE Pedicled flaps (PFs) have historically served as the preferred option for reconstruction of large chest wall defects. More recently, the indications for microvascular-free flaps (MVFFs) have increased, particularly for defects in which PFs are inadequate or unavailable. We sought to compare oncologic and surgical outcomes between MVFFs and PFs in reconstructions of full-thickness chest wall defects. METHODS We retrospectively identified all patients who underwent chest wall resection at our institution from 2000 to 2022. Patients were stratified by flap reconstruction. End points were defect size, rate of complete resection, rate of local recurrence, and postoperative outcomes. Multivariable analysis was performed to identify factors associated with complications at 30 days. RESULTS In total, 536 patients underwent chest wall resection, of whom 133 had flap reconstruction (MVFF, n = 28; PF, n = 105). The median (interquartile range) covered defect size was 172 cm2 (100-216 cm2) for patients receiving MVFF versus 109 cm2 (75-148 cm2) for patients receiving PF (P = .004). The rate of R0 resection was high in both groups (MVFF, 93% [n = 26]; PF, 86% [n = 90]; P = .5). The rate of local recurrence was 4% in MVFF patients (n = 1) versus 12% in PF patients (n = 13, P = .3). Postoperative complications were not statistically different between groups (odds ratio for PF, 1.37; 95% confidence interval, 0.39-5.14]; P = .6). Operative time >400 minutes was associated with 30-day complications (odds ratio, 3.22; 95% confidence interval, 1.10-9.93; P = .033). CONCLUSIONS Patients with MVFFs had larger defects, a high rate of complete resection, and a low rate of local recurrence. MVFFs are a valid option for chest wall reconstructions.
Collapse
Affiliation(s)
- Stijn Vanstraelen
- Thoracic Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Barkat Ali
- Plastic and Reconstructive Surgery Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Manjit S Bains
- Thoracic Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Farooq Shahzad
- Plastic and Reconstructive Surgery Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Robert J Allen
- Plastic and Reconstructive Surgery Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Evan Matros
- Plastic and Reconstructive Surgery Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Joe Dycoco
- Thoracic Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Prasad S Adusumilli
- Thoracic Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Matthew J Bott
- Thoracic Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Robert J Downey
- Thoracic Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY
| | - James Huang
- Thoracic Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY
| | - James M Isbell
- Thoracic Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Daniela Molena
- Thoracic Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Bernard J Park
- Thoracic Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Valerie W Rusch
- Thoracic Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Smita Sihag
- Thoracic Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Peter G Cordeiro
- Plastic and Reconstructive Surgery Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Michelle R Coriddi
- Plastic and Reconstructive Surgery Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Joseph H Dayan
- Plastic and Reconstructive Surgery Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Joseph Disa
- Plastic and Reconstructive Surgery Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Colleen M McCarthy
- Plastic and Reconstructive Surgery Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Jonas A Nelson
- Plastic and Reconstructive Surgery Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Carrie Stern
- Plastic and Reconstructive Surgery Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Babak Mehrara
- Plastic and Reconstructive Surgery Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY
| | - David R Jones
- Thoracic Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY; Fiona and Stanley Druckenmiller Center for Lung Cancer Research, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Gaetano Rocco
- Thoracic Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY; Fiona and Stanley Druckenmiller Center for Lung Cancer Research, Memorial Sloan Kettering Cancer Center, New York, NY.
| |
Collapse
|
5
|
Ruyssinck L, De Graeve L, De Bruycker A, Monten C, Lootens L, De Ryck F, Van Landuyt K. Chest wall reconstruction for deep radiation necrosis: case report and overview of surgical options. Acta Chir Belg 2023; 123:566-572. [PMID: 35545943 DOI: 10.1080/00015458.2022.2076026] [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: 01/21/2022] [Accepted: 05/06/2022] [Indexed: 11/01/2022]
Abstract
INTRODUCTION To report a case of radiation necrosis after reirradiation for breast cancer and the difficulties encountered when treating these complex cases. PATIENTS AND METHODS We present an 86-year-old woman with a history of right-sided intraductal breast cancer treated with a right mastectomy followed by local adjuvant radiotherapy (50 Gray). Twelve years later, she was diagnosed with a local recurrence in the mastectomy scar which was treated with local resection (including resection of rib four) and adjuvant radiotherapy up to 32 Gray. In July 2020 she presents at the Department of Plastic and Reconstructive Surgery with a chronic ulcer on the right-sided hemithorax. RESULTS A multi-staged, multidisciplinary approach was necessary to secure lasting coverage of the extensive defect. CONCLUSION Thoracic radiation necrosis should be subject to a multidisciplinary approach (plastic and thoracic surgeons) pre-, per-, and post-operatively. Each case may require a different surgical approach depending on the size and depth of the defect, patients' age, comorbidities, and previous medical treatment.
Collapse
Affiliation(s)
- Laure Ruyssinck
- Department of Plastic, Reconstructive and Aesthetic Surgery, Ghent University Hospital, Ghent, Belgium
| | - L De Graeve
- Department of Plastic, Reconstructive and Aesthetic Surgery, Ghent University Hospital, Ghent, Belgium
| | - A De Bruycker
- Department of Radiotherapy, Ghent University Hospital, Ghent, Belgium
| | - C Monten
- Department of Radiotherapy, Ghent University Hospital, Ghent, Belgium
| | - L Lootens
- Department of Thoracovascular Surgery, Ghent University Hospital, Ghent, Belgium
| | - F De Ryck
- Department of Thoracovascular Surgery, Ghent University Hospital, Ghent, Belgium
| | - K Van Landuyt
- Department of Plastic, Reconstructive and Aesthetic Surgery, Ghent University Hospital, Ghent, Belgium
| |
Collapse
|
6
|
Khamitov K, Dudek W, Arkudas A, Haj Khalaf M, Parjiea C, Higaze M, Horch RE, Sirbu H. Interdisciplinary Treatment of Malignant Chest Wall Tumors. J Pers Med 2023; 13:1405. [PMID: 37763172 PMCID: PMC10532685 DOI: 10.3390/jpm13091405] [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: 08/21/2023] [Revised: 09/15/2023] [Accepted: 09/18/2023] [Indexed: 09/29/2023] Open
Abstract
BACKGROUND Chest wall resections for malignant chest wall tumors (MCWTs), particularly those with full-thickness chest wall involvement requiring reconstruction, present a therapeutic challenge for thoracic and plastic reconstructive surgeons. The purpose of this study was to review our experience with chest wall resection for primary and metastatic MCWTs, with a focus on perioperative outcomes and postoperative overall survival (OS). METHODS All patients who underwent surgical resection for primary and secondary MCWTs at our single institution between 2000 and 2019 were retrospectively analyzed. RESULTS A total of 42 patients (25 male, median age 60 years) operated upon with curative (n = 37, 88.1%) or palliative (n = 5, 11.9%) intent were reviewed. Some 33 (78%) MCWTs were of secondary origin. Chest wall reconstruction was required in 40 (95%) cases. A total of 13 (31%) patients had postoperative complications and one (2.3%) died perioperatively. The 5-year postoperative overall survival rate was 51.9%. The postoperative 5-year survival rate of 42.6% in patients with secondary MCWTs was significantly lower compared to the figure of 87.5% in patients with primary MCWTs. CONCLUSIONS In well-selected patients, chest wall resections for primary and secondary MCWTs are feasible and associated with good perioperative outcomes. For secondary MCWTs, surgery can also be performed with palliative intent.
Collapse
Affiliation(s)
- Koblandy Khamitov
- Faculty of Medicine, Friedrich-Alexander-University Erlangen-Nürnberg, 91054 Erlangen, Germany
- Department of Thoracic Surgery, University Hospital Erlangen, Krankenhausstr. 12, 91054 Erlangen, Germany
| | - Wojciech Dudek
- Faculty of Medicine, Friedrich-Alexander-University Erlangen-Nürnberg, 91054 Erlangen, Germany
- Department of Thoracic Surgery, University Hospital Erlangen, Krankenhausstr. 12, 91054 Erlangen, Germany
| | - Andreas Arkudas
- Faculty of Medicine, Friedrich-Alexander-University Erlangen-Nürnberg, 91054 Erlangen, Germany
- Department of Plastic and Hand Surgery, University Hospital Erlangen, 91054 Erlangen, Germany
| | - Mohamed Haj Khalaf
- Faculty of Medicine, Friedrich-Alexander-University Erlangen-Nürnberg, 91054 Erlangen, Germany
- Department of Thoracic Surgery, University Hospital Erlangen, Krankenhausstr. 12, 91054 Erlangen, Germany
| | - Chirag Parjiea
- Faculty of Medicine, Friedrich-Alexander-University Erlangen-Nürnberg, 91054 Erlangen, Germany
- Department of Thoracic Surgery, University Hospital Erlangen, Krankenhausstr. 12, 91054 Erlangen, Germany
| | - Mostafa Higaze
- Faculty of Medicine, Friedrich-Alexander-University Erlangen-Nürnberg, 91054 Erlangen, Germany
- Department of Thoracic Surgery, University Hospital Erlangen, Krankenhausstr. 12, 91054 Erlangen, Germany
| | - Raymund E. Horch
- Faculty of Medicine, Friedrich-Alexander-University Erlangen-Nürnberg, 91054 Erlangen, Germany
- Department of Plastic and Hand Surgery, University Hospital Erlangen, 91054 Erlangen, Germany
| | - Horia Sirbu
- Faculty of Medicine, Friedrich-Alexander-University Erlangen-Nürnberg, 91054 Erlangen, Germany
- Department of Thoracic Surgery, University Hospital Erlangen, Krankenhausstr. 12, 91054 Erlangen, Germany
| |
Collapse
|
7
|
Min S, Choi J, Na KJ, Hong KY. Infective Costochondritis after Augmentation Mammoplasty: A Rare Case Report and Review of the Literature. Arch Plast Surg 2023; 50:488-491. [PMID: 37808331 PMCID: PMC10556329 DOI: 10.1055/a-2088-2829] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2023] [Accepted: 04/15/2023] [Indexed: 10/10/2023] Open
Abstract
Silicone breast implant insertion is a commonly performed surgical procedure for breast augmentation or reconstruction. Among various postoperative complications, infection is one of the main causes of patient readmission and may ultimately require explantation. We report a case of infective costochondritis after augmentation mammoplasty, which has rarely been reported and is therefore difficult to diagnose. A 36-year-old female visited the clinic for persistent redness, pain, and purulent discharge around the left anteromedial chest, even after breast implant explantation. Magnetic resonance imaging showed abscess formation encircling the left fourth rib and intracartilaginous and bone marrow signal alteration at the left body of the sternum and left fourth rib. En bloc resection of partial rib and adjacent sternum were done and biopsy results confirmed infective costochondritis. Ten months postoperatively, the patient underwent chest wall reconstruction with an artificial bone graft and acellular dermal matrix. As shown in this case, early and aggressive surgical debridement of the infected costal cartilage and sternum should be performed for infective costochondritis. Furthermore, delayed chest wall reconstruction could significantly contribute to the quality of life.
Collapse
Affiliation(s)
- Sally Min
- Department of Plastic and Reconstructive Surgery, Seoul National University College of Medicine, Seoul National University Hospital, Seoul, Republic of Korea
| | - Jinil Choi
- Department of Plastic and Reconstructive Surgery, Seoul National University College of Medicine, Seoul National University Hospital, Seoul, Republic of Korea
| | - Kwon Joong Na
- Department of Thoracic and Cardiovascular Surgery, Seoul National University Hospital, Seoul, Republic of Korea
| | - Ki Yong Hong
- Department of Plastic and Reconstructive Surgery, Seoul National University College of Medicine, Seoul National University Hospital, Seoul, Republic of Korea
| |
Collapse
|
8
|
Vaidya S, Karmacharya RM, Khadka S, Pokharel S, Yadav B, Sharma S, Kunwar K, Bhatt S. Ewing's sarcoma arising from the right sided chest wall: a case report. Ann Med Surg (Lond) 2023; 85:3709-3713. [PMID: 37427176 PMCID: PMC10328691 DOI: 10.1097/ms9.0000000000000994] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2022] [Accepted: 06/10/2023] [Indexed: 07/11/2023] Open
Abstract
Ewing sarcoma (ES) is a malignant tumour prevalent in young adults with a reported 5-year survival ranging between 40 and 60% in most studies. Majority of the patients with ES are usually diagnosed late with significant chest wall mass, chest pain or respiratory distress. Case presentation Here, the authors present a case of a 21-year-old female with a diagnosis of right sided chest wall ES treated with neoadjuvant chemotherapy followed by surgical resection of the mass. Clinical findings and investigations The patient presented to the Surgical OPD with shortness of breath for 6 months associated with chest pain on the right side. Radiological investigations including chest X-ray and multi-detector row computed tomography chest was done. Additionally, diagnosis of ES was confirmed with histopathological examination of the mass obtained from fine needle aspiration cytology. Interventions and outcome She was planned for safe maximal resection of tumour with chest wall reconstruction using double prolene mesh with bone cement and the defect was sutured with adjacent ribs. Good outcome was noted on postoperative period with resolution of symptoms. Relevance and impact This procedure is now commonly used and is considered as an effective treatment for chest wall tumours, which was also noted in our case and the procedure is also well tolerated.
Collapse
Affiliation(s)
- Satish Vaidya
- Cardio Thoracic and Vascular Surgery Unit, Department of Surgery, Kathmandu University School of Medical Sciences
| | - Robin Man Karmacharya
- Cardio Thoracic and Vascular Surgery Unit, Department of Surgery, Kathmandu University School of Medical Sciences
| | - Saurav Khadka
- Cardio Thoracic and Vascular Surgery Unit, Department of Surgery, Kathmandu University School of Medical Sciences
| | - Selene Pokharel
- Kathmandu University School of Medical Sciences, Dhulikhel Hospital, Dhulikhel, Nepal
| | - Binay Yadav
- Cardio Thoracic and Vascular Surgery Unit, Department of Surgery, Kathmandu University School of Medical Sciences
| | - Sanjay Sharma
- Cardio Thoracic and Vascular Surgery Unit, Department of Surgery, Kathmandu University School of Medical Sciences
| | - Kajol Kunwar
- Cardio Thoracic and Vascular Surgery Unit, Department of Surgery, Kathmandu University School of Medical Sciences
| | - Swechha Bhatt
- Kathmandu University School of Medical Sciences, Dhulikhel Hospital, Dhulikhel, Nepal
| |
Collapse
|
9
|
Dietz MD, Zelmanski MH, Choueiri MA. Radical Resection of Locally Advanced Chest Wall cSCC With Muscle Flap Reconstruction. Am Surg 2023:31348231175107. [PMID: 37139866 DOI: 10.1177/00031348231175107] [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] [Indexed: 05/05/2023]
Abstract
Outcomes in those with advanced cutaneous squamous cell carcinoma (cSCC) are poor. Upon incidence of metastasis, the mortality rate has been shown to be >70% with median overall survival (OS) of less than 2 years. While there is no standardized combination and multimodal therapy recommendation for advanced cases, there is a significant necessity to include surgical intervention for improved locoregional control of disease and improved OS. Currently, Cisplatin as monotherapy or combination with Fluorouracil (5-FU), and radiotherapy followed by surgical intervention are the most likely regimens used in the treatment of advanced cSCC. Secondary chemotherapy options include carboplatin and paclitaxel. Here, we report the effectiveness of neoadjuvant chemoradiotherapy (CRT) using carboplatin and paclitaxel agents with intensity modulated radiation therapy (IMRT) followed by radical surgical resection, and later, muscle flap reconstruction with split-thickness skin grafting to treat a very high-risk Stage IV cSCC of the left chest wall.
Collapse
Affiliation(s)
- Matthew D Dietz
- Department of General Surgery, West Virginia University School of Medicine- Charleston Division, Charleston Area Medical Center, Charleston, WV, USA
| | - Mark H Zelmanski
- Department of General Surgery, West Virginia University School of Medicine- Charleston Division, Charleston Area Medical Center, Charleston, WV, USA
| | - Mark A Choueiri
- Department of General Surgery, West Virginia University School of Medicine- Charleston Division, Charleston Area Medical Center, Charleston, WV, USA
| |
Collapse
|
10
|
宋 达, 李 赞, 章 一. [Effectiveness of lobulated pedicled rectus abdominis myocutaneous flap for repairing huge chest wall defect]. Zhongguo Xiu Fu Chong Jian Wai Ke Za Zhi 2023; 37:473-477. [PMID: 37070317 PMCID: PMC10110752 DOI: 10.7507/1002-1892.202212101] [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] [Subscribe] [Scholar Register] [Received: 12/30/2022] [Revised: 03/27/2023] [Accepted: 03/27/2023] [Indexed: 04/19/2023]
Abstract
Objective To explore the effectiveness of lobulated pedicled rectus abdominis myocutaneous flap to repair huge chest wall defect. Methods Between June 2021 and June 2022, 14 patients with huge chest wall defects were treated with radical resection of the lesion and lobulated pedicled rectus abdominis myocutaneous flap transplantation for reconstruction of chest wall defects. The patients included 5 males and 9 females with an average age of 44.2 years (range, 32-57 years). The size of skin and soft tissue defect ranged from 20 cm×16 cm to 22 cm×22 cm. The bilateral pedicled rectus abdominis myocutaneous flaps in size of 26 cm×8 cm to 35 cm×14 cm were prepaired and cut into two skin paddles with basically equal area according to the actual defect size of the chest wall. After the lobulated pedicled rectus abdominis myocutaneous flap was transferred to the defect, there were two reshaping methods. The first method was that the skin paddle at the lower position and opposite side was unchanged, and the skin paddle at the effected side was rotated by 90° (7 cases). The second method was that the two skin paddles were rotated 90° respectively (7 cases). The donor site was sutured directly. Results All 14 flaps survived successfully and the wound healed by first intention. The incisions at donor site healed by first intention. All patients were followed up 6-12 months (mean, 8.7 months). The appearance and texture of the flaps were satisfactory. Only linear scar was left at the donor site, and the appearance and activity of the abdominal wall were not affected. No local recurrence was found in all tumor patients, and distant metastasis occurred in 2 breast cancer patients (1 liver metastasis and 1 lung metastasis). Conclusion The lobulated pedicled rectus abdominis myocutaneous flap in repair of huge chest wall defect can ensure the safety of blood supply of the flap to the greatest extent, ensure the effective and full use of the flap tissue, and reduce postoperative complications.
Collapse
Affiliation(s)
- 达疆 宋
- 湖南省肿瘤医院肿瘤整形外科(长沙 410008)Department of Oncology Plastic Surgery, Hunan Cancer Hospital, Changsha Hunan, 410008, P. R. China
| | - 赞 李
- 湖南省肿瘤医院肿瘤整形外科(长沙 410008)Department of Oncology Plastic Surgery, Hunan Cancer Hospital, Changsha Hunan, 410008, P. R. China
| | - 一新 章
- 湖南省肿瘤医院肿瘤整形外科(长沙 410008)Department of Oncology Plastic Surgery, Hunan Cancer Hospital, Changsha Hunan, 410008, P. R. China
| |
Collapse
|
11
|
Jo GY, Ki SH. Analysis of the Chest Wall Reconstruction Methods after Malignant Tumor Resection. Arch Plast Surg 2023; 50:10-16. [PMID: 36755660 PMCID: PMC9902099 DOI: 10.1055/s-0042-1760290] [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: 02/27/2022] [Accepted: 11/02/2022] [Indexed: 02/09/2023] Open
Abstract
Background The chest wall defects can be caused by various reasons. In the case of malignant tumor resection of the chest wall, it is essential to reconstruct the chest wall to cover the vital tissue and restore the pulmonary function with prevention of paradoxical motion. With our experience, we analyzed and evaluated the results and complications of the chest wall reconstructions followed by malignant tumor resection. Methods From 2013 to 2022, we reviewed a medical record of patients who received chest reconstruction due to chest wall malignant tumor resection. The following data were retrieved: patients' demographic data, tumor type, type of operation, method of chest wall reconstruction of the soft and skeletal tissue and complications. Results There were seven males and six female patients. The causes of reconstruction were 12 primary tumors and one metastatic carcinoma. The pathological types were seven sarcomas, three invasive breast carcinoma, and three squamous cell carcinomas. The skeletal reconstruction was performed in six patients. The series of the flap were eight pedicled latissimus dorsi (LD) myocutaneous flaps, two pectoralis major myocutaneous flap, two vertical rectus abdominis myocutaneous free flap, and one LD free flap. Among all the cases, only one staged reconstruction and successful reconstruction without flail chest. Most of the complications were atelectasis. Conclusion In the case of accompanying multiple ribs and sternal defect, skeletal reconstruction would need skeletal reconstruction to prevent paradoxical chest wall motion. The flap for soft tissue defect be selected according to defect size and location of chest wall. With our experience, we recommend the reconstruction algorithm for chest wall defect due to malignant tumor resection.
Collapse
Affiliation(s)
- Gang Yeon Jo
- Department of Plastic and Reconstructive Surgery, Inha University Hospital, Incheon, South Korea
| | - Sae Hwi Ki
- Department of Plastic and Reconstructive Surgery, Inha University Hospital, Incheon, South Korea,Department of Plastic and Reconstructive Surgery, School of Medicine, Inha University, Incheon, South Korea,Address for correspondence Sae Hwi Ki, MD, PhD Department of Plastic and Reconstructive SurgeryInha University School of Medicine, 27 Inhang-ro, Jung-gu, Incheon 400-711South Korea
| |
Collapse
|
12
|
Kreutz-Rodrigues L, Gibreel W, Moran SL, Mardini S, Bite U, Stulak JM, Wigle D, Pochettino A, Bakri K. The Utility of the Omentum Flap for Complex Intrathoracic Problems. Plast Surg (Oakv) 2023; 31:17-23. [PMID: 36755825 PMCID: PMC9900042 DOI: 10.1177/22925503211024745] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [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: 04/06/2020] [Accepted: 04/30/2021] [Indexed: 11/17/2022] Open
Abstract
Introduction: Omentum flap is a viable reconstructive option for complex chest wall and mediastinal reconstruction. The impact of vasoconstrictors and the laminar pattern of blood flow associated with left ventricular assist devices (LVADs) on the outcomes of reconstructions has not been thoroughly evaluated. Methods: A retrospective review of all patients who underwent chest wall or mediastinal reconstruction using pedicled omentum flaps between 2003 and 2019. Results: Forty patients (60% males) underwent chest wall or mediastinal reconstruction using a pedicled omentum flap at a mean age of 58 years. The median follow-up was 24.3 months. The most common indication was the reconstruction of anterior chest wall/sternal defects (n = 16), followed by coverage of repaired bronchopleural fistula (n = 6), osteoradionecrosis of the anterolateral chest wall (n = 5), reconstruction of anterior/lateral chest wall following oncologic resections (n = 5), coverage of replaced infected LVAD (n = 4), and coverage of exposed/replaced aortic root vascular grafts (n = 4). Vasoconstrictors were used in 26 patients (65%). Eight flaps had partial necrosis, and none of the flaps had complete necrosis. There was no difference in flap complication rates in patients who received vasoconstrictors during the case compared to those who did not (P = 1.0). Thirteen (33%) flaps were skin grafted at a median of 13 days with 100% skin graft viability. Abdominal incisional hernia developed in 8 patients. In patients with LVADs, the omentum remained viable during the follow-up period. Conclusion: The ability of the omentum to easily reach various regions in the chest and the low failure rate make this flap a reliable reconstructive method.
Collapse
Affiliation(s)
| | - Waleed Gibreel
- Division of Plastic Surgery, Department of Surgery, Mayo Clinic,
Rochester, MN, USA
| | - Steven L. Moran
- Division of Plastic Surgery, Department of Surgery, Mayo Clinic,
Rochester, MN, USA
| | - Samir Mardini
- Division of Plastic Surgery, Department of Surgery, Mayo Clinic,
Rochester, MN, USA
| | - Uldis Bite
- Division of Plastic Surgery, Department of Surgery, Mayo Clinic,
Rochester, MN, USA
| | - John M. Stulak
- Division of Cardiovascular Surgery, Department of Surgery, Mayo
Clinic, Rochester, MN, USA
| | - Dennis Wigle
- Division of Thoracic Surgery, Department of Surgery, Mayo Clinic,
Rochester, MN, USA
| | - Alberto Pochettino
- Division of Cardiovascular Surgery, Department of Surgery, Mayo
Clinic, Rochester, MN, USA
| | - Karim Bakri
- Division of Plastic Surgery, Department of Surgery, Mayo Clinic,
Rochester, MN, USA
| |
Collapse
|
13
|
Young JS, McAllister M, Marshall MB. Three-dimensional technologies in chest wall resection and reconstruction. J Surg Oncol 2023; 127:336-342. [PMID: 36630098 DOI: 10.1002/jso.27164] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [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: 10/14/2022] [Revised: 11/22/2022] [Accepted: 11/23/2022] [Indexed: 01/12/2023]
Abstract
Resection and reconstruction of the chest wall can pose unique challenges given its vital role in the protection of the thoracic viscera and the dynamic part it plays in respiration. A number of new three-dimensional (3D) technologies may be invaluable in tackling these challenges. Herein we review the use of 3D technologies in preoperative imaging with virtual 3D models, printing of 3D models for preoperative planning, and printing of 3D prostheses when approaching complex chest wall reconstruction.
Collapse
Affiliation(s)
- John S Young
- Division of Thoracic and Cardiac Surgery, Harvard Medical School, Brigham and Women's Hospital, Boston, Massachusetts, USA.,Division of Thoracic Surgery, Veterans Affairs Boston Healthcare System, Boston, Massachusetts, USA
| | - Miles McAllister
- Division of Thoracic and Cardiac Surgery, Harvard Medical School, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - M Blair Marshall
- Division of Thoracic and Cardiac Surgery, Harvard Medical School, Brigham and Women's Hospital, Boston, Massachusetts, USA
| |
Collapse
|
14
|
Goldsmith I, Dovgalski L, Evans PL. 3D Printing Technology for Chest Wall Reconstruction With a Sternum-Ribs-Cartilage Titanium Implant: From Ideation to Creation. Innovations (Phila) 2023; 18:67-72. [PMID: 36803147 DOI: 10.1177/15569845231153632] [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] [Indexed: 02/22/2023]
Abstract
OBJECTIVE We describe the use of 3-dimensional (3D) printing technology to plan and reconstruct the sternum, adjoining cartilages, and ribs with a custom-made, anatomically designed, 3D-printed titanium implant for an isolated sternal metastasis complicated with a pathological fracture. METHODS We imported submillimeter slice computed tomography scan data into Mimics Medical 20.0 software and by manual bone threshold segmentation created a 3D virtual model of the patient's chest wall and tumor. For all-around tumor-free margins, we grew the tumor by 2 cm. The replacement implant was designed in 3D using the anatomical features of the sternum, cartilages, and ribs and manufactured using TiMG 1 powder fusion technology. Physiotherapy was provided prior to and following surgery, and the impact of reconstruction on pulmonary functions was assessed. RESULTS At surgery, the precise resection, clear margins, and a secure fit were achieved. At follow-up, there was no dislocation, paradoxical movement, change in performance status, or dyspnea. There was a decrease in forced expiratory volume in 1 s (FEV1) from 105% prior to surgery to 82% following surgery and in forced vital capacity (FVC) from 108% to 75%, with no difference in the FEV1/FVC ratio, suggesting a restrictive pattern of impairment. CONCLUSIONS With 3D printing technology, reconstructing a large anterior chest wall defect with a custom-made, anatomical, 3D-printed titanium alloy implant is feasible and safe, and it preserves the shape, structure, and function of the chest wall, albeit with a restrictive pattern of pulmonary function, which can be addressed with physiotherapy.
Collapse
Affiliation(s)
- Ira Goldsmith
- Department of Cardiothoracic Surgery, Morriston Hospital, Swansea, Wales, UK
| | - Lawrence Dovgalski
- Maxillofacial Laboratory Services, Morriston Hospital, Swansea, Wales, UK
| | | |
Collapse
|
15
|
Li Y, Liu K, Yang Y, Zhao T, Guo X, Wang L. Mastery of chest wall reconstruction with a titanium sternum-rib fixation system: a case series. J Thorac Dis 2022; 14:5064-5072. [PMID: 36647466 PMCID: PMC9840024 DOI: 10.21037/jtd-22-1686] [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: 11/07/2022] [Accepted: 12/20/2022] [Indexed: 12/31/2022]
Abstract
Background Chest wall disease is a common disease in thoracic surgery. For most chest wall lesions, surgical resection is the mainstay of treatment. Reconstruction is indicated for a wide range of chest wall defects. Currently, various reconstruction materials are used in clinic, including 3D printing materials and various types of metal materials. At present, most of the studies using titanium sternum-rib fixation system for reconstruction are case reports. The purpose of this paper is to analyze the experience to discuss our essential surgical techniques for treating various types of chest wall reconstruction with a titanium sternum-rib fixation system over the last 5 years. Case Description A retrospective analysis was performed on patients with chest wall tumors treated with a titanium sternum-rib fixation system in our center from 2016 to 2020. Chest wall reconstruction techniques, experiences, postoperative complications, and quality of life including chest discomfort, chronic pain, average time to return to normal life, chest wall deformity after resection for various types of chest wall tumors were analyzed. In this study, a total of 57 patients were successfully operated without chest wall deformity and return to daily life early. With an average of 2.3 ribs removed, including 10 procedures involving sternotomy and reconstruction and 3 procedures involving sternoclavicular joint resection and reconstruction. The follow-up time of the whole group ranged from 3 months to 5 years. Postoperative chest discomfort occurred in 6 patients during follow-up; 2 patients had chronic pain. The average time to return to normal life was 1.4 months. One patient developed a deformed depression of the chest wall, and 2 patients developed wound infections. There was no perioperative death. Conclusions In our clinical experience, the titanium sternum-rib fixation system is safe, effective, and feasible. The technique is straightforward. The early and middle postoperative curative effect is satisfactory and can be used clinically.
Collapse
Affiliation(s)
- Yang Li
- Department of Thoracic Surgery, Shanghai Sixth People's Hospital, Shanghai, China
| | - Kaibin Liu
- Department of Thoracic Surgery, Shanghai Sixth People's Hospital, Shanghai, China
| | - Yi Yang
- Department of Thoracic Surgery, Shanghai Sixth People's Hospital, Shanghai, China
| | - Tiancheng Zhao
- Department of Thoracic Surgery, Shanghai Sixth People's Hospital, Shanghai, China
| | - Xiang Guo
- Department of Thoracic Surgery, Shanghai Sixth People's Hospital, Shanghai, China
| | - Lei Wang
- Department of Thoracic Surgery, Shanghai Sixth People's Hospital, Shanghai, China
| |
Collapse
|
16
|
Horriat NL, McCandless MG, Humphries LS, Ghanamah M, Kogon BE, Hoppe IC. Management of pediatric sternal wounds following congenital heart surgery: The role of the plastic surgeon in debridement and closure. J Card Surg 2022; 37:3695-3702. [PMID: 35979680 DOI: 10.1111/jocs.16841] [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: 05/23/2022] [Revised: 07/23/2022] [Accepted: 07/25/2022] [Indexed: 11/30/2022]
Abstract
BACKGROUND Management of sternal wound infections (SWIs) in pediatric patients following congenital heart surgery can be extremely difficult. Patients with congenital cardiac conditions are at risk for complications such as sternal dehiscence, infection, and cardiopulmonary compromise. In this study, we report a single-institution experience with pediatric SWIs. METHODS Fourteen pediatric patients requiring plastic surgery consultation for complex sternal wound closure were included. A retrospective chart review was performed with the following variables of interest: demographic data, congenital cardiac condition, respective surgical palliations, development of mediastinitis, causative organism, number of debridements, presence of sternal wires, and choice of flap coverage. Primary endpoints included achieved chest wall closure and overall survival. RESULTS Of the 14 patients, 8 (57%) were diagnosed with culture-positive mediastinitis. The sternum remained wired at the time of final flap closure in eight (57%) patients. All patients were reconstructed with pectoralis major flaps, except one (7%) who also received an omental flap and two (14%) who received superior rectus abdominis flaps. One patient (7%) was treated definitively with negative pressure wound therapy, and one (7%) was too unstable for closure. Six patients developed complications, including one (7%) with persistent mediastinitis, two (14%) with hematoma formation, one (7%) with abscess, and one (7%) with skin necrosis requiring subsequent surgical debridement. There were three (21%) mortalities. CONCLUSIONS The management of SWI in congenital cardiac patients is challenging. The standard tenets for management of SWI in adults are loosely applicable, but additional considerations must be addressed in this unique subset population.
Collapse
Affiliation(s)
- Narges L Horriat
- Division of Plastic and Reconstructive Surgery, Department of Surgery, University of Mississippi Medical Center, Jackson, Mississippi, USA
| | - Martin G McCandless
- Division of Plastic and Reconstructive Surgery, Department of Surgery, University of Mississippi Medical Center, Jackson, Mississippi, USA
| | - Laura S Humphries
- Division of Plastic and Reconstructive Surgery, Department of Surgery, University of Mississippi Medical Center, Jackson, Mississippi, USA
| | - Mohammed Ghanamah
- Division of Cardiothoracic Surgery, Department of Surgery, University of Mississippi Medical Center, Jackson, Mississippi, USA
| | - Brian E Kogon
- Division of Cardiothoracic Surgery, Department of Surgery, University of Mississippi Medical Center, Jackson, Mississippi, USA
| | - Ian C Hoppe
- Division of Plastic and Reconstructive Surgery, Department of Surgery, University of Mississippi Medical Center, Jackson, Mississippi, USA
| |
Collapse
|
17
|
Thumerel M, Belaroussi Y, Prisciandaro E, Chermat A, Zarrouki S, Chevalier B, Rodriguez A, Hustache-Castaing R, Jougon J. Immersive Three-dimensional Computed Tomography to Plan Chest Wall Resection for Lung Cancer. Ann Thorac Surg 2022; 114:2379-2382. [PMID: 35963442 DOI: 10.1016/j.athoracsur.2022.06.059] [Citation(s) in RCA: 1] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/13/2021] [Revised: 04/28/2022] [Accepted: 06/18/2022] [Indexed: 11/01/2022]
Abstract
PURPOSE Chest wall resections for lung cancer treatment remain difficult to plan using standard two-dimensional computed tomography. Although virtual reality headsets have been used in many medical contexts, they have not been employed in chest wall resection planning. DESCRIPTION We compared preoperative planning of a chest wall surgical resection for lung cancer treatment between senior and resident surgeons who used an immersive virtual reality device and a two-dimensional computed tomography. EVALUATION Chest wall resection planning was more accurate when surgeons used virtual reality versus computed tomography analysis (28.6% vs. 18.3%, p = 0.018), and this was particularly true in the resident surgeon group (27.4% vs. 8.3%, p = 0.0025). Predictions regarding the need for chest wall substitutes were also more accurate when they were made using virtual reality versus computed tomography analysis in all groups (96% vs. 68.5%, p < 0.0001). Other studied parameters were not affected by use of the virtual reality tool. CONCLUSION Virtual reality may offer enhanced accuracy for chest wall resection and reconstruction planning for lung cancer treatment.
Collapse
Affiliation(s)
- Matthieu Thumerel
- Thoracic Surgery Department, Haut Lévêque Hospital, Bordeaux University Hospital and Bordeaux University, ave de Magellan, 33604 Pessac, Bordeaux, France; INSERM, Centre de Recherche Cardio-thoracique de Bordeaux, U1045, CIC 1401, F-33000 Bordeaux, France.
| | - Yaniss Belaroussi
- Thoracic Surgery Department, Haut Lévêque Hospital, Bordeaux University Hospital and Bordeaux University, ave de Magellan, 33604 Pessac, Bordeaux, France
| | - Elena Prisciandaro
- Thoracic Surgery Department, Haut Lévêque Hospital, Bordeaux University Hospital and Bordeaux University, ave de Magellan, 33604 Pessac, Bordeaux, France
| | - Anaelle Chermat
- Thoracic Surgery Department, Haut Lévêque Hospital, Bordeaux University Hospital and Bordeaux University, ave de Magellan, 33604 Pessac, Bordeaux, France
| | - Sarah Zarrouki
- Thoracic Surgery Department, Haut Lévêque Hospital, Bordeaux University Hospital and Bordeaux University, ave de Magellan, 33604 Pessac, Bordeaux, France
| | - Benjamin Chevalier
- Thoracic Surgery Department, Haut Lévêque Hospital, Bordeaux University Hospital and Bordeaux University, ave de Magellan, 33604 Pessac, Bordeaux, France
| | - Arnaud Rodriguez
- Thoracic Surgery Department, Haut Lévêque Hospital, Bordeaux University Hospital and Bordeaux University, ave de Magellan, 33604 Pessac, Bordeaux, France
| | - Romain Hustache-Castaing
- Thoracic Surgery Department, Haut Lévêque Hospital, Bordeaux University Hospital and Bordeaux University, ave de Magellan, 33604 Pessac, Bordeaux, France
| | - Jacques Jougon
- Thoracic Surgery Department, Haut Lévêque Hospital, Bordeaux University Hospital and Bordeaux University, ave de Magellan, 33604 Pessac, Bordeaux, France
| |
Collapse
|
18
|
Abstract
OBJECTIVE To investigate the application of anterior serratus branch of thoracodorsal vessel in repairing chest wall defect. METHODS Between October 2018 and March 2021, bilateral free lower abdominal flaps were used to repair large-area complex defects after chest wall tumor surgery in 23 patients. The patients were all female; the age ranged from 23 to 71 years, with an average age of 48.5 years. There were 11 cases of locally advanced breast cancer, 4 cases of phyllodes cell sarcoma, 3 cases of soft tissue sarcoma, 3 cases of recurrence of breast cancer, and 2 case of osteoradionecrosis. The size of secondary chest wall defect after tumor resection and wound debridement ranged from 20 cm×10 cm to 38 cm×14 cm, the size of flap ranged from 25 cm×12 cm to 38 cm×15 cm, the length of vascular pedicle was 9-12 cm (mean, 11.4 cm). Fourteen cases of simple soft tissue defects were repaired by flap transplantation; 5 cases of rib defects (<3 ribs) and soft tissue defects were repaired by simple mesh combined with flap transplantation; and 4 cases of full-thickness chest wall defect with large-scale rib defect (>3 ribs) were repaired by "mesh plus bone cement" rigid internal fixation combined with flap transplantation. The anterior serratus branch of thoracodorsal vessel was selected as the recipient vessel in all cases, the revascularization methods include 3 types: the proximal end of the anterior serratus branch plus other recipient vessels (13 cases), proximal and distal ends of anterior serratus branch (6 cases), and proximal ends of two anterior serratus branches (4 cases). RESULTS The main trunk of thoracodorsal vessels was preserved completely in 23 patients. All patients were followed up 10-18 months, with an average of 13.9 months. After operation, the flap survived completely, the shape of reconstructed chest wall was good, the texture was satisfactory, and there was no flap contracture deformation. There was only a linear scar left in the flap donor site, and the abdominal wall function was not significantly affected. There was no tumor recurrence during follow-up. CONCLUSION The anterior serratus branch of thoracodorsal vessel has a constant anatomy and causes little damage to the recipient site, so it can provide reliable blood supply for free flap transplantation.
Collapse
|
19
|
扩大股前外侧肌皮瓣在超大面积胸壁缺损修复中的应用. Zhongguo Xiu Fu Chong Jian Wai Ke Za Zhi 2022; 36. [PMID: 35848179 DOI: 10.7507/1002-1892.202202001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
Abstract
OBJECTIVE To investigate the application of expanded anterolateral thigh myocutaneous flap in the repair of huge chest wall defect. METHODS Between August 2018 and December 2020, 12 patients, including 4 males and 8 females, were treated with expanded anterolateral thigh myocutaneous flap to repair huge complex defects after thoracic wall tumor surgery. The age ranged from 28 to 72 years, with an average of 54.9 years. There were 4 cases of phyllodes cell sarcoma, 2 cases of soft tissue sarcoma, 1 case of metastatic chest wall tumor of lung cancer, and 5 cases of breast cancer recurrence. All cases underwent 2-7 tumor resection operations, of which 3 cases had previously received lower abdominal flap transplantation and total flap failure occurred, the other 9 cases were thin and were not suitable to use the abdomen as the flap donor site. After thorough debridement, the area of secondary chest wall defect was 300-600 cm 2; the length of the flap was (24.7±0.7) cm, the width of the skin island was (10.6±0.7) cm, the length of the lateral femoral muscular flap was (26.8±0.5) cm, the width was (15.3±0.6) cm, and the length of the vascular pedicle was (7.9±0.6) cm. RESULTS The myocutaneous flaps and the skin grafts on the muscular flaps were all survived in 11 patients, and the wounds in the donor and recipient sites healed by first intention. One male patient had a dehiscence of the chest wall incision, which was further repaired by omentum combined with skin graft. The appearance of the reconstructed chest wall in 12 patients was good, the texture was satisfactory, and there was no skin flap contracture and deformation. Only linear scar was left in the donor site of the flap, and slight hyperplastic scar was left in the skin harvesting site, which had no significant effect on the function of the thigh. All patients were followed up 9-15 months, with an average of 12.6 months. No tumor recurrence was found. CONCLUSION The expanded anterolateral thigh myocutaneous flap surgery is easy to operate, the effective repair area is significantly increased, and multiple flap transplantation is avoided. It can be used as a rescue means for the repair of huge chest wall defects.
Collapse
|
20
|
Goldsmith I. Chest Wall Reconstruction With 3D Printing: Anatomical and Functional Considerations. Innovations (Phila) 2022; 17:191-200. [PMID: 35699725 DOI: 10.1177/15569845221102138] [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] [Indexed: 11/16/2022]
Abstract
Large chest wall defects, as a result of wide local excision of chest wall pathology, require skeletal and soft-tissue reconstruction to restore the anatomical shape, structure, and respiratory function of the thorax. Reconstruction is challenging and requires the surgical reconstructive team to understand the anatomic and physiologic morbidity related to the defect and the choice of reconstructive techniques available to restore form and function. Rapidly emerging 3-dimensional (3D) printing technology allows the reconstructive surgical team to customize the therapeutic process of skeletal reconstruction by accurately mimicking the shape and structure of the chest wall being replaced. An integrated knowledge of the anatomy, physiology, mechanics of breathing, and respiratory tests is important to restore form and function. The focus of this article is to review the anatomy, physiology, and assessment of respiratory function from the classical textbooks and integrate this knowledge with the precise anatomy of the chest wall created by 3D printing technology. By doing so, this article will demonstrate how 3D printing may help the reconstructive team to understand the anatomic and physiologic morbidity related to the chest wall defect and the importance of taking each of these aspects into consideration when undertaking chest wall reconstruction of the thorax.
Collapse
Affiliation(s)
- Ira Goldsmith
- Department of Cardiothoracic Surgery, 97701Morriston Hospital, Swansea Bay University Health Board, Wales, UK
| |
Collapse
|
21
|
Wang L, Yan X, Zhao J, Chen C, Chen C, Chen J, Chen KN, Cao T, Chen MW, Duan H, Fan J, Fu J, Gao S, Guo H, Guo S, Guo W, Han Y, Jiang GN, Jiang H, Jiao WJ, Kang M, Leng X, Li HC, Li J, Li J, Li SM, Li S, Li Z, Li Z, Liang C, Mao NQ, Mei H, Sun D, Wang D, Wang L, Wang Q, Wang S, Wang T, Liu L, Xiao G, Xu S, Yang J, Ye T, Zhang G, Zhang L, Zhao G, Zhao J, Zhong WZ, Zhu Y, Hulsewé KWE, Vissers YLJ, de Loos ER, Jeong JY, Marulli G, Sandri A, Sziklavari Z, Vannucci J, Ampollini L, Ueda Y, Liu C, Bille A, Hamaji M, Aramini B, Inci I, Pompili C, Van Veer H, Fiorelli A, Sara R, Sarkaria IS, Davoli F, Kuroda H, Bölükbas S, Li XF, Huang L, Jiang T. Expert consensus on resection of chest wall tumors and chest wall reconstruction. Transl Lung Cancer Res 2022; 10:4057-4083. [PMID: 35004239 PMCID: PMC8674598 DOI: 10.21037/tlcr-21-935] [Citation(s) in RCA: 21] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2021] [Accepted: 11/26/2021] [Indexed: 02/05/2023]
Abstract
Chest wall tumors are a relatively uncommon disease in clinical practice. Most of the published studies about chest wall tumors are usually single-center retrospective studies, involving few patients. Therefore, evidences regarding clinical conclusions about chest wall tumors are lacking, and some controversial issues have still to be agreed upon. In January 2019, 73 experts in thoracic surgery, plastic surgery, science, and engineering jointly released the Chinese Expert Consensus on Chest Wall Tumor Resection and Chest Wall Reconstruction (2018 edition). After that, numerous experts put forward new perspectives on some academic issues in this version of the consensus, pointing out the necessity to further discuss the points of contention. Thus, we conducted a survey through the administration of a questionnaire among 85 experts in the world. Consensus has been reached on some major points as follows. (I) Wide excision should be performed for desmoid tumor (DT) of chest wall. After excluding the distant metastasis by multi-disciplinary team, solitary sternal plasmacytoma can be treated with extensive resection and adjuvant radiotherapy. (II) Wide excision with above 2 cm margin distance should be attempted to obtain R0 resection margin for chest wall tumor unless the tumor involves vital organs or structures, including the great vessels, heart, trachea, joints, and spine. (III) For patients with chest wall tumors undergoing unplanned excision (UE) for the first time, it is necessary to carry out wide excision as soon as possible within 1–3 months following the previous surgery. (IV) Current Tumor Node Metastasis staging criteria (American Joint Committee on Cancer) of bone tumor and soft tissue sarcoma are not suitable for chest wall sarcomas. (V) It is necessary to use rigid implants for chest wall reconstruction once the maximum diameter of the chest wall defect exceeds 5 cm in adults and adolescents. (VI) For non-small cell lung cancer (NSCLC) invading the chest wall, wide excision with neoadjuvant and/or adjuvant therapy are recommended for patients with stage T3-4N0-1M0. As clear guidelines are lacking, these consensus statements on controversial issues on chest wall tumors and resection could possibly serve as further guidance in clinical practice during the upcoming years.
Collapse
Affiliation(s)
- Lei Wang
- Department of Thoracic Surgery, Tangdu Hospital, Air Force Medical University, Xi'an, China
| | - Xiaolong Yan
- Department of Thoracic Surgery, Tangdu Hospital, Air Force Medical University, Xi'an, China
| | - Jinbo Zhao
- Department of Thoracic Surgery, Tangdu Hospital, Air Force Medical University, Xi'an, China
| | - Chang Chen
- Department of Thoracic Surgery, Shanghai Pulmonary Hospital, Tongji University School of Medicine, Shanghai, China
| | - Chun Chen
- Department of Thoracic Surgery, Fujian Medical University Union Hospital, Fuzhou, China
| | - Jun Chen
- Tianjin Key Laboratory of Lung Cancer Metastasis and Tumor Microenvironment, Lung Cancer Institute, Tianjin Medical University General Hospital, Tianjin, China
| | - Ke-Neng Chen
- Department of Thoracic Surgery, Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education), Peking University Cancer Hospital & Institute, Beijing, China
| | - Tiesheng Cao
- Department of Ultrasound Diagnosis, Tangdu Hospital, Air Force Medical University, Xi'an, China
| | - Ming-Wu Chen
- Department of Cardiothoracic Surgery, The First Affiliated Hospital of Guangxi Medical University, Nanning, China
| | - Hongbin Duan
- Department of Thoracic Surgery, Zhongshan Hospital Affiliated to Xiamen University, Xiamen, China
| | - Junqiang Fan
- Department of Thoracic Surgery, Second Affiliated Hospital of Zhejiang University, School of Medicine, Hangzhou, China
| | - Junke Fu
- Department of Thoracic Surgery, First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China
| | - Shugeng Gao
- Department of Thoracic Surgery, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | | | | | - Wei Guo
- Department of Thoracic Surgery, Daping Hospital, Army Medical University, Chongqing, China
| | - Yongtao Han
- Department of Thoracic Surgery, Sichuan Cancer Hospital & Research Institute, School of Medicine, University of Electronic Science and Technology of China (UESTC), Chengdu, China
| | - Ge-Ning Jiang
- Department of Thoracic Surgery, Shanghai Pulmonary Hospital, Tongji University School of Medicine, Shanghai, China
| | - Hongjing Jiang
- Department of Minimally Invasive Esophageal Surgery, Key Laboratory of Cancer Prevention and Therapy, National Clinical Research Center for Cancer, Tianjin Medical University Cancer Institute and Hospital, Tianjin, China
| | - Wen-Jie Jiao
- Department of Thoracic Surgery, The Affiliated Hospital of Qingdao University, Qingdao, China
| | - Mingqiang Kang
- Department of Thoracic Surgery, Fujian Medical University Union Hospital, Fuzhou, China
| | - Xuefeng Leng
- Department of Thoracic Surgery, Sichuan Cancer Hospital & Research Institute, School of Medicine, University of Electronic Science and Technology of China (UESTC), Chengdu, China
| | - He-Cheng Li
- Department of Thoracic Surgery, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Jing Li
- Department of Plastic and Burn Surgery, Tangdu Hospital, Air Force Medical University, Xi'an, China
| | - Jian Li
- Department of Thoracic Surgery, Peking University Third Hospital, Beijing, China
| | - Shao-Min Li
- Department of Thoracic Surgery, the Second Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China
| | - Shuben Li
- Department of Thoracic Surgery, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | - Zhigang Li
- Department of Thoracic Surgery, Section of Esophageal Surgery, Shanghai Chest Hospital, Shanghai Jiao Tong University, Shanghai, China
| | - Zhongcheng Li
- Department of Thoracic and Cadiovascular Surgery, Affiliated Hospital of Qinghai University, Xining, China
| | - Chaoyang Liang
- Department of Thoracic Surgery, China-Japan Friendship Hospital, Beijing, China
| | - Nai-Quan Mao
- Department of Thoracic Surgery, Tumor Hospital Affiliated to Guangxi Medical University, Nanning, China
| | - Hong Mei
- Department of Thoracic Surgery, Guizhou Provincial People's Hospital, Guiyang, China
| | - Daqiang Sun
- Department of Thoracic Surgery, Tianjin Chest Hospital, Tianjin, China
| | - Dong Wang
- Department of Cardiothoracic Surgery, Affiliated Taikang Xianlin Drum Tower Hospital, Medical School of Nanjing University, Nanjing, China
| | - Luming Wang
- Department of Thoracic Surgery, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Qun Wang
- Department of Thoracic Surgery, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Shumin Wang
- Department of Thoracic Surgery, General Hospital of Shenyang Military Area, Shenyang, China
| | - Tianhu Wang
- Department of Thoracic Surgery, The Third Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Lunxu Liu
- Department of Thoracic Surgery, West China Hospital, Sichuan University, Chengdu, China
| | - Gaoming Xiao
- Department of Thoracic Surgery, Hunan Cancer Hospital and the Affiliated Cancer Hospital of Xiangya School of Medicine, Central South University, Changsha, China
| | - Shidong Xu
- Department of Thoracic Surgery and Oncology, Harbin Medical University Cancer Hospital, Harbin, China
| | - Jinliang Yang
- Department of Thoracic Surgery, The Third Hospital of Hebei Medical University, Shijiazhuang, China
| | - Ting Ye
- Department of Thoracic Surgery, Shanghai Cancer Center, Fudan University, Shanghai, China
| | - Guangjian Zhang
- Department of Thoracic Surgery, First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China
| | - Linyou Zhang
- Department of Thoracic Surgery, The Second Affiliated Hospital of Harbin Medical University, Harbin, China
| | - Guofang Zhao
- Department of Cardiothoracic Surgery, Hwa Mei Hospital (Ningbo No. 2 Hospital), University of Chinese Academy of Sciences, Ningbo, China
| | - Jun Zhao
- Department of Thoracic Surgery, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Wen-Zhao Zhong
- Guangdong Provincial Key Laboratory of Translational Medicine in Lung Cancer, Guangdong Lung Cancer Institute, Guangdong Provincial People's Hospital and Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Yuming Zhu
- Department of Thoracic Surgery, Shanghai Pulmonary Hospital, Tongji University School of Medicine, Shanghai, China
| | - Karel W E Hulsewé
- Division of General Thoracic Surgery, Department of Surgery, Zuyderland Medical Center, Heerlen, The Netherlands
| | - Yvonne L J Vissers
- Division of General Thoracic Surgery, Department of Surgery, Zuyderland Medical Center, Heerlen, The Netherlands
| | - Erik R de Loos
- Division of General Thoracic Surgery, Department of Surgery, Zuyderland Medical Center, Heerlen, The Netherlands
| | - Jin Yong Jeong
- Department of Thoracic and Cardiovascular Surgery, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Giuseppe Marulli
- Department of Emergency and Organ Transplantation, Thoracic Surgery Unit, University Hospital of Bari, Bari, Italy
| | - Alberto Sandri
- Thoracic Surgery Division, Department of Oncology, San Luigi Gonzaga Hospital, Orbassano (To), Italy
| | - Zsolt Sziklavari
- Department of Thoracic Surgery, Klinikum Coburg, Coburg, Germany.,Department of Thoracic Surgery, University Medical Center Regensburg, Regensburg, Germany
| | - Jacopo Vannucci
- Department of Thoracic Surgery, University of Rome Sapienza, Policlinico Umberto I, Rome, Italy
| | - Luca Ampollini
- Thoracic Surgery, Department of Medicine and Surgery, University Hospital of Parma, Parma, Italy
| | - Yuichiro Ueda
- Department of General Thoracic, Breast and Pediatric Surgery, School of Medicine, Fukuoka University, Fukuoka, Japan
| | - Chaozong Liu
- Institute of Orthopaedic & Musculoskeletal Science, Division of Surgery & Interventional Science, University College London, Royal National Orthopaedic Hospital, London, UK
| | - Andrea Bille
- Department of Thoracic Surgery, Guy's Hospital, London, UK
| | - Masatsugu Hamaji
- Department of Thoracic Surgery, Kyoto University Hospital, Kyoto, Japan
| | - Beatrice Aramini
- Division of Thoracic Surgery, Department of Medical and Surgical Sciences, University of Modena and Reggio Emilia, Modena, Italy
| | - Ilhan Inci
- Department of Thoracic Surgery, University Hospital, Raemistrasse, Zurich, Switzerland
| | | | - Hans Van Veer
- Department of Thoracic Surgery, University Hospitals Leuven, Leuven, Belgium
| | - Alfonso Fiorelli
- Thoracic Surgery Unit, University of Campania Luigi Vanvitelli, Naples, Italy
| | - Ricciardi Sara
- Division of Thoracic Surgery, San Camillo Forlanini Hospital, Rome, Italy
| | - Inderpal S Sarkaria
- Department of Thoracic Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | - Fabio Davoli
- Department of Thoracic Surgery, AUSL Romagna, S. Maria delle Croci Teaching Hospital, Ravenna, Italy
| | - Hiroaki Kuroda
- Department of Thoracic Surgery, Aichi Cancer Center Hospital, Nagoya, Japan
| | - Servet Bölükbas
- Department of Thoracic Surgery, Evang. Kliniken Essen-Mitte, Essen, Germany
| | - Xiao-Fei Li
- Department of Thoracic Surgery, Tangdu Hospital, Air Force Medical University, Xi'an, China
| | - Lijun Huang
- Department of Thoracic Surgery, Tangdu Hospital, Air Force Medical University, Xi'an, China
| | - Tao Jiang
- Department of Thoracic Surgery, Tangdu Hospital, Air Force Medical University, Xi'an, China
| |
Collapse
|
22
|
Topolnitskiy EB, Shefer NA, Marchenko ES, Chekalkin TL, Khakimov KI. [Reconstruction of post-resection chest wall defects in surgical treatment of invasive non-small cell lung cancer]. Khirurgiia (Mosk) 2022:31-40. [PMID: 36469466 DOI: 10.17116/hirurgia202212131] [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] [Indexed: 06/17/2023]
Abstract
OBJECTIVE To present the results of reconstruction of post-resection chest wall defects with nickel-titanium (TiNi) implants in patients with invasive NSCLC and to analyze the features of perioperative management. MATERIAL AND METHODS We enrolled 9 patients with NSCLC involving the ribs after lobectomy or pneumonectomy with chest wall reconstruction. Defects were closed used TiNi mesh and rib prostheses. We selected the shape and dimensions of artificial ribs individually before surgery according to CT data and 3D models of reinforcing elements. RESULTS There were male smokers aged 64.6±4.6 years among patients (range 58-73). T3N0M0 was diagnosed in 6 patients, T3N1M0 - 2, T3N2M0 - 1. Squamous cell carcinoma was verified in 4 (44.4%) patients, adenocarcinoma - in 5 (55.6%) patients. All patients had comorbidities. Mean Charlson's comorbidity index was 6.56±4.6. Dimension of chest wall defect varied from 78 to 100 cm2. Postoperative period was uneventful without signs of respiratory failure. There were no lethal outcomes. Complications occurred in 33.3% of patients (prolonged air discharge through the drains, pleuritis and atrial fibrillation). CONCLUSION Surgical treatment of NSCLC spreading to the chest wall is a complex task requiring further improvement. Bioadaptive TiNi implants are a promising reinforcing material that allows successful reconstruction of post-resection chest wall defects with good anatomical, functional and cosmetic results. «Sandwich» technology is advisable for extensive defects. This approach includes 2 layers of knitted mesh and rib prostheses between these layers.
Collapse
Affiliation(s)
- E B Topolnitskiy
- Siberian State Medical University, Tomsk, Russia
- Regional Clinical Hospital, Tomsk, Russia
- Tomsk State University, Tomsk, Russia
| | - N A Shefer
- Siberian State Medical University, Tomsk, Russia
- Regional Clinical Hospital, Tomsk, Russia
| | | | | | - Kh I Khakimov
- Research Institute of Oncology of the Tomsk National Research Medical Center, Tomsk, Russia
| |
Collapse
|
23
|
Topolnitskiy E, Chekalkin T, Marchenko E, Yasenchuk Y, Kang SB, Kang JH, Obrosov A. Evaluation of Clinical Performance of TiNi-Based Implants Used in Chest Wall Repair after Resection for Malignant Tumors. J Funct Biomater 2021; 12:jfb12040060. [PMID: 34842727 PMCID: PMC8628886 DOI: 10.3390/jfb12040060] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [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: 10/08/2021] [Revised: 11/06/2021] [Accepted: 11/08/2021] [Indexed: 12/14/2022] Open
Abstract
In this study, we assessed the outcomes after surgical treatment of thoracic post-excision defects in 15 patients, using TiNi knitted surgical meshes and customized artificial TiNi-based ribs. Methods: Eight patients were diagnosed with advanced non-small cell lung cancer (NSCLC) invading the chest wall, of which five patients were T3N0M0, two were T3N1M0, and one was T3N2M0. Squamous cell carcinoma was identified in three of these patients and adenocarcinoma in five. In two cases, chest wall resection and repair were performed for metastases of kidney cancer after radical nephrectomy. Three-dimensional CT reconstruction and X-ray scans were used to plan the surgery and customize the reinforcing TiNi-based implants. All patients received TiNi-based devices and were prospectively followed for a few years. Results: So far, there have been no lethal outcomes, and all implanted devices were consistent in follow-up examinations. Immediate complications were noted in three cases (ejection of air through the pleural drains, paroxysm of atrial fibrillation, and pleuritis), which were conservatively managed. In the long term, no complications, aftereffects, or instability of the thoracic cage were observed. Conclusion: TiNi-based devices used for extensive thoracic lesion repair in this context are promising and reliable biomaterials that demonstrate good functional, clinical, and cosmetic outcomes.
Collapse
Affiliation(s)
- Evgeniy Topolnitskiy
- Laboratory of Medical Materials, Tomsk State University, 634045 Tomsk, Russia; (E.T.); (E.M.); (Y.Y.); (A.O.)
- Department of Surgery, Siberian State Medical University, 634050 Tomsk, Russia
| | - Timofey Chekalkin
- Laboratory of Medical Materials, Tomsk State University, 634045 Tomsk, Russia; (E.T.); (E.M.); (Y.Y.); (A.O.)
- R&D Center, TiNiKo Co., Ochang 28119, Korea;
- Correspondence:
| | - Ekaterina Marchenko
- Laboratory of Medical Materials, Tomsk State University, 634045 Tomsk, Russia; (E.T.); (E.M.); (Y.Y.); (A.O.)
| | - Yuri Yasenchuk
- Laboratory of Medical Materials, Tomsk State University, 634045 Tomsk, Russia; (E.T.); (E.M.); (Y.Y.); (A.O.)
| | - Seung-Baik Kang
- Boramae Medical Center, Seoul National University Hospital, Seoul 07061, Korea;
| | | | - Aleksei Obrosov
- Laboratory of Medical Materials, Tomsk State University, 634045 Tomsk, Russia; (E.T.); (E.M.); (Y.Y.); (A.O.)
- Department of Physical Metallurgy and Materials Technology, Brandenburg University of Technology, 03-046 Cottbus, Germany
| |
Collapse
|
24
|
Wang L, Song D, Song A, Li Z, Zhou B, Lü C, Tang Y. [Application of modified designed bilobed latissimus dorsi myocutaneous flap in chest wall reconstruction of locally advanced breast cancer patients]. Zhongguo Xiu Fu Chong Jian Wai Ke Za Zhi 2021; 35:1172-1176. [PMID: 34523284 DOI: 10.7507/1002-1892.202102049] [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] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
Objective To explore the effectiveness of the modified designed bilobed latissimus dorsi myocutaneous flap in chest wall reconstruction of locally advanced breast cancer (LABC) patients. Methods Between January 2016 and June 2019, 64 unilateral LABC patients were admitted. All patients were female with an average age of 41.3 years (range, 34-50 years). The disease duration ranged from 6 to 32 months (mean, 12.3 months). The diameter of primary tumor ranged from 4.8 to 14.2 cm (mean, 8.59 cm). The size of chest wall defect ranged from 16 cm×15 cm to 20 cm×20 cm after modified radical mastectomy/radical mastectomy. All defects were reconstructed with the modified designed bilobed latissimus dorsi myocutaneous flaps, including 34 cases with antegrade method and 30 cases with retrograde method. The size of skin paddle ranged from 13 cm×5 cm to 17 cm×6 cm. All the donor sites were closed directly. Results In antegrade group, 2 flaps (5.8%, 2/34) showed partial necrosis; in retrograde group, 6 flaps (20%, 6/30) showed partial necrosis, 5 donor sites (16.7%, 5/30) showed partial necrosis; and all of them healed after dressing treatment. The other flaps survived successfully and incisions in donor sites healed by first intention. There was no significant difference in the incidence of partial necrosis between antegrade and retrograde groups ( χ 2=2.904, P=0.091). The difference in delayed healing rate of donor site between the two groups was significant ( P=0.013). The patients were followed up 15-30 months, with an average of 23.1 months. The appearance and texture of the flaps were satisfactory, and only linear scar left in the donor site. No local recurrence was found in all patients. Four patients died of distant metastasis, including 2 cases of liver metastasis, 1 case of brain metastasis, and 1 case of lung metastasis. The average survival time was 22.6 months (range, 20-28 months). Conclusion The modified designed bilobed latissimus dorsi myocutaneous flap can repair chest wall defect after LABC surgery. Antegrade design of the flap can ensure the blood supply of the flap and reduce the tension of the donor site, decrease the incidence of complications.
Collapse
Affiliation(s)
- Lei Wang
- Department of Breast and Thyroid Surgery, Affiliated Hospital of Shandong University of Traditional Chinese Medicine, Jinan Shandong, 250014, P.R.China
| | - Dajiang Song
- Department of Oncology Plastic Surgery, Hunan Province Cancer Hospital, Changsha Hunan, 410008, P.R.China
| | - Aili Song
- Department of Breast and Thyroid Surgery, Affiliated Hospital of Shandong University of Traditional Chinese Medicine, Jinan Shandong, 250014, P.R.China
| | - Zan Li
- Department of Oncology Plastic Surgery, Hunan Province Cancer Hospital, Changsha Hunan, 410008, P.R.China
| | - Bo Zhou
- Department of Oncology Plastic Surgery, Hunan Province Cancer Hospital, Changsha Hunan, 410008, P.R.China
| | - Chunliu Lü
- Department of Oncology Plastic Surgery, Hunan Province Cancer Hospital, Changsha Hunan, 410008, P.R.China
| | - Yuanyuan Tang
- Department of Oncology Plastic Surgery, Hunan Province Cancer Hospital, Changsha Hunan, 410008, P.R.China
| |
Collapse
|
25
|
Gritsiuta AI, Bracken A, Downs P, Lara-Gutierrez J, Beebe K, Pechetov AA, Petrov RV. Surgical management of rare benign tumors of the sternum. ACTA ACUST UNITED AC 2021; 11:88-94. [PMID: 34395895 PMCID: PMC8360399 DOI: 10.15406/mojcr.2021.11.00389] [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] [Indexed: 11/06/2022]
Abstract
Primary benign tumors of the sternum are an exceedingly rare entity. Surgical techniques regarding intervention for these lesions are not clearly defined in the literature given their scarcity. Operative techniques include en-bloc resection of the tumor, and this has proven to be successful in preventing local recurrence despite benign nature of the lesion. Given the often extensive defect created by the excision, reconstruction is frequently necessary; depending on the size of the defect, either autologous bone grafting or the use of synthetic materials may be indicated. This study serves to present two cases of rare primary benign tumors of the sternum, giant cell tumors and osteoma spongiosum and to summarize the available literature. We present a review of the literature of 17sternal giant cell tumor cases reported so far including our patient and unique case of osteoma spongiosum of the sternum, that discusses their surgical management, as well as reconstructive techniques that provided an excellent clinical result and a lack of recurrence on long term follow-up.
Collapse
Affiliation(s)
- Andrei I Gritsiuta
- Department of Surgical Services, University of Pittsburgh Medical Center, USA.,Department of Thoracic Surgery, Vishnevsky National Medical Research Center of Surgery, Russia
| | - Alexander Bracken
- Department of Surgical Services, University of Pittsburgh Medical Center, USA
| | - Patrick Downs
- Department of Surgical Services, University of Pittsburgh Medical Center, USA
| | | | - Karisa Beebe
- Department of Surgical Services, University of Pittsburgh Medical Center, USA
| | - Alexei A Pechetov
- Department of Thoracic Surgery, Vishnevsky National Medical Research Center of Surgery, Russia
| | - Roman V Petrov
- Department of Thoracic Medicine and Surgery, Lewis Katz School of Medicine at Temple University, USA
| |
Collapse
|
26
|
Vasudevan S, Vaidya S, S RB, C AB, N AY, Nagireddy SR. Temporary Extrathoracic Vacuum Therapy Splint in Chest Wall Reconstruction. Indian J Plast Surg 2021; 54:211-214. [PMID: 34239247 PMCID: PMC8257296 DOI: 10.1055/s-0041-1729502] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Background
Paradoxical respiration is a sinister consequence of bony chest cage defects which can persist even post chest wall reconstruction. It leads to prolonged dependence on mechanical ventilation postoperatively, thereby delaying recovery.
Methods
Negative pressure wound therapy (NPWT) was applied in early postoperative period to a patient with chest wall defect reconstructed with folded prolene mesh and free anterolateral thigh flap. Arterial blood gas (ABG), fraction of inspired oxygen (FiO
2
), peak end expiratory pressure (PEEP), oxygen saturation (SpO
2
), and blood pressure (BP) readings pre and post NPWT application were compared.
Results
There was marked improvement in the breathing mechanics and related parameters post NPWT application over the flap.
Conclusions
Negative extrathoracic pressure in the form of a temporary splint can enable early weaning off the ventilator and a smoother postoperative recovery in reconstructed chest wall defects.
Collapse
Affiliation(s)
- Srikanth Vasudevan
- Department of Plastic and Reconstructive Surgery, Manipal Hospital, Bangalore, India
| | - Shriram Vaidya
- Department of Critical Care Medicine, Manipal Hospital, Bangalore, India
| | - Ritu Baath S
- Department of Plastic and Reconstructive Surgery, Manipal Hospital, Bangalore, India
| | - Ashok Basur C
- Department of Plastic and Reconstructive Surgery, Manipal Hospital, Bangalore, India
| | | | | |
Collapse
|
27
|
Pau CP, Chong KS, Yakub MA, Khalil AA. Single-stage open repair of severe asymmetric pectus excavatum and mitral valve replacement in connective tissue disease. Asian Cardiovasc Thorac Ann 2021; 30:480-482. [PMID: 33947231 DOI: 10.1177/02184923211014004] [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] [Indexed: 11/15/2022]
Abstract
We present a 14-year-old boy with Loey-Dietz syndrome with severe mitral regurgitation, pectus excavatum and scoliosis. The Haller index was 25. The heart was displaced into the left hemithorax. The right inferior pulmonary vein was very close to the sternum and vertebral body. Single-stage surgery was performed. An osseo-myo-cutaneous pedicled flap was created by sterno-manubrial junction dislocation and rib resection with bilateral internal mammary arteries supplying the flap. Cardiopulmonary bypass and mitral valve replacement was performed. The defect was bridged with three straight plates. The flap was laid on top and anchored. Early outcome at three months was good.
Collapse
Affiliation(s)
- Cheong Ping Pau
- Department of Cardiothoracic Surgery, Institut Jantung Negara, Kuala Lumpur, Malaysia
| | - Kee Soon Chong
- Department of Cardiothoracic Surgery, Institut Jantung Negara, Kuala Lumpur, Malaysia
| | - Mohd Azhari Yakub
- Department of Cardiothoracic Surgery, Institut Jantung Negara, Kuala Lumpur, Malaysia
| | | |
Collapse
|
28
|
Pechetov AA, Zotikov AE, Karmazanovsky GG, Volchansky DA, Kulbak VA. [Additional vascularization of the omental flap using mammary-gastroepiploic bypass grafting in the treatment of deep sternal wound infection]. Khirurgiia (Mosk) 2021:104-110. [PMID: 34941217 DOI: 10.17116/hirurgia2021121104] [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] [Indexed: 06/14/2023]
Abstract
Incidence of postoperative sternomediastinitis depends on various risk factors and makes up 8%. Surgical debridement with local management of the wound are used to achieve wound sterility. In some cases, sternectomy or subtotal sternal resection are performed for total sternal osteomyelitis with osteoporotic bone and multiple fractures. This procedure results an extensive bone defect. The final stage is anterior chest wall reconstruction. The most popular method is wound closure with autologous muscle or omental flaps. The authors describe a patient with sternomediastinitis who underwent staged treatment. At the final stage, subtotal sternectomy with simultaneous omentoplasty were performed. Additionally, mammary-gastroepiploic bypass grafting with right internal mammary artery and right gastroepiploic artery was carried out for additional vascularization of the omental flap. We found no similar surgery for sternomediastinitis in the literature. Long-term treatment outcome was followed-up (>50 months of relapse-free period and good quality of life).
Collapse
Affiliation(s)
- A A Pechetov
- Vishnevsky National Medical Research Center of Surgery, Moscow, Russia
| | - A E Zotikov
- Vishnevsky National Medical Research Center of Surgery, Moscow, Russia
| | - G G Karmazanovsky
- Vishnevsky National Medical Research Center of Surgery, Moscow, Russia
| | - D A Volchansky
- Vishnevsky National Medical Research Center of Surgery, Moscow, Russia
| | - V A Kulbak
- Vishnevsky National Medical Research Center of Surgery, Moscow, Russia
| |
Collapse
|
29
|
Basharkhah A, Lackner H, Karastaneva A, Bergovec M, Spendel S, Castellani C, Sorantin E, Benesch M, Liegl-Atzwanger B, Smolle-Jüttner FM, Urban C, Höllwarth M, Singer G, Till H. Interdisciplinary Radical "En-Bloc" Resection of Ewing Sarcoma of the Chest Wall and Simultaneous Chest Wall Repair Achieves Excellent Long-Term Survival in Children and Adolescents. Front Pediatr 2021; 9:661025. [PMID: 33791262 PMCID: PMC8005523 DOI: 10.3389/fped.2021.661025] [Citation(s) in RCA: 3] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/30/2021] [Accepted: 02/23/2021] [Indexed: 01/04/2023] Open
Abstract
Introduction: Ewing sarcomas of the chest wall, historically known as "Askin tumors" represent highly aggressive pediatric malignancies with a reported 5-year survival ranging only between 40 and 60% in most studies. Multimodal oncological treatment according to specific Ewing sarcoma protocols and radical "en-bloc" resection with simultaneous chest wall repair are key factors for long-term survival. However, the surgical complexity depends on tumor location and volume and potential infiltrations into lung, pericardium, diaphragm, esophagus, spine and major vessels. Thus, the question arises, which surgical specialties should join their comprehensive skills when approaching a child with Ewing sarcoma of the chest wall. Patients and Methods: All pediatric patients with Ewing sarcomas of the chest wall treated between 1990 and 2020 were analyzed focusing on complete resection, chest wall reconstruction, surgical complications according to Clavien-Dindo (CD) and survival. Patients received neo-adjuvant chemotherapy according to the respective Ewing sarcoma protocols. Depending on tumor location and organ infiltration, a multi-disciplinary surgical team was orchestrated to perform radical en-bloc resection and simultaneous chest wall repair. Results: Thirteen consecutive patients (seven boys and six girls) were included. Median age at presentation was 10.9 years (range 2.2-21 years). Neo-adjuvant chemotherapy (n = 13) and irradiation (n = 3) achieved significant reduction of the median tumor volume (305.6 vs. 44 ml, p < 0.05). En-bloc resection and simultaneous chest wall reconstruction was achieved without major complications despite multi-organ involvement. Postoperatively, one patient with infiltration of the costovertebral joint and laminectomy required surgical re-intervention (CD IIIb). 11/13 patients were treated with clear resections margins (R1 resection in one patient with infiltration of the costovertebral joint and marginal resection <1 mm in one child with multiple pulmonary metastases). All patients underwent postoperative chemotherapy; irradiation was performed in four children. Two deaths occurred 18 months and 7.5 years after diagnosis, respectively. Median follow-up for the remaining patients was 8.8 years (range: 0.9-30.7 years). The 5-year survival rate was 89% and the overall survival 85%. Conclusion: EWING specific oncological treatment and multi-disciplinary surgery performing radical en-bloc resections and simultaneous chest wall repair contribute to an improved survival of children with Ewing sarcoma of the chest wall.
Collapse
Affiliation(s)
- Alireza Basharkhah
- Department of Pediatric and Adolescent Surgery, Medical University of Graz, Graz, Austria
| | - Herwig Lackner
- Division of Pediatric Hematology-Oncology, Department of Pediatrics and Adolescent Medicine, Medical University of Graz, Graz, Austria
| | - Anna Karastaneva
- Division of Pediatric Hematology-Oncology, Department of Pediatrics and Adolescent Medicine, Medical University of Graz, Graz, Austria
| | - Marko Bergovec
- Department of Orthopedics and Trauma, Medical University of Graz, Graz, Austria
| | - Stephan Spendel
- Division of Plastic, Aesthetic and Reconstructive Surgery, Department of Surgery, Medical University of Graz, Graz, Austria
| | - Christoph Castellani
- Department of Pediatric and Adolescent Surgery, Medical University of Graz, Graz, Austria
| | - Erich Sorantin
- Division of Pediatric Radiology, Department of Radiology, Medical University of Graz, Graz, Austria
| | - Martin Benesch
- Division of Pediatric Hematology-Oncology, Department of Pediatrics and Adolescent Medicine, Medical University of Graz, Graz, Austria
| | | | - Freyja-Maria Smolle-Jüttner
- Division of Thoracic and Hyperbaric Surgery, Department of Surgery, Medical University of Graz, Graz, Austria
| | - Christian Urban
- Division of Pediatric Hematology-Oncology, Department of Pediatrics and Adolescent Medicine, Medical University of Graz, Graz, Austria
| | - Michael Höllwarth
- Department of Pediatric and Adolescent Surgery, Medical University of Graz, Graz, Austria
| | - Georg Singer
- Department of Pediatric and Adolescent Surgery, Medical University of Graz, Graz, Austria
| | - Holger Till
- Department of Pediatric and Adolescent Surgery, Medical University of Graz, Graz, Austria
| |
Collapse
|
30
|
Harijee A, Vijayaraghavan S, Marathi AR, Kottayil BP, Kappanayil M, Bayya PR, Jayashankar JP. Complete Sternal Cleft Repair. Indian J Plast Surg 2020; 53:419-422. [PMID: 33402776 PMCID: PMC7775229 DOI: 10.1055/s-0040-1721547] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022] Open
Abstract
Sternal cleft (SC) is a rare congenital malformation which can be partial or complete. We report a case of complete SC in a 9-month-old child. Our technique involves a combination of reinforcement with the deep cervical fascial extension, followed by the anterior perichondrial flaps, bridged with the rib graft, incorporating surplus resected cartilaginous xiphoid process, and covered with the bilateral pectoralis major muscle flap for the chest wall reconstruction with 3D printing assisting preoperative planning. The size of the defect in relation to the age of presentation was a deciding factor in the adoption of this alternative surgical technique.
Collapse
Affiliation(s)
- Ankita Harijee
- Department of Plastic & Reconstructive Surgery, Amrita Institute of Medical Sciences & Research Centre, Kochi, India
| | - Sundeep Vijayaraghavan
- Department of Plastic & Reconstructive Surgery, Amrita Institute of Medical Sciences & Research Centre, Kochi, India
| | - Arjun Reddy Marathi
- Department of Plastic & Reconstructive Surgery, Amrita Institute of Medical Sciences & Research Centre, Kochi, India
| | - Brijesh Parayaru Kottayil
- Department of Cardiovascular & Thoracic Surgery, Amrita Institute of Medical Sciences & Research Centre, Kochi, India
| | - Mahesh Kappanayil
- Department of Paediatric Cardiology, AIMS 3D Printing & Innovation Laboratory, Amrita Institute of Medical Sciences & Research Centre, Kochi, India
| | - Praveen Reddy Bayya
- Department of Cardiovascular & Thoracic Surgery, Amrita Institute of Medical Sciences & Research Centre, Kochi, India
| | - Jessin P Jayashankar
- Department of Anesthesiology, Amrita Institute of Medical Sciences & Research Centre, Kochi, India
| |
Collapse
|
31
|
Lodin D, Florio T, Genuit T, Hus N. Negative Pressure Wound Therapy Can Prevent Surgical Site Infections Following Sternal and Rib Fixation in Trauma Patients: Experience From a Single-Institution Cohort Study. Cureus 2020; 12:e9389. [PMID: 32850255 PMCID: PMC7445111 DOI: 10.7759/cureus.9389] [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: 06/08/2020] [Accepted: 07/25/2020] [Indexed: 11/23/2022] Open
Abstract
The management of patients with traumatic injuries can be a challenge. Many require surgical intervention, are at an increased risk of surgical site infections (SSIs), and have an associated increase in hospital length of stay and cost. Closed-incision negative pressure therapy (ciNPT) has shown benefits in the management of certain surgical sites by preventing infection and improving wound healing. In the setting of chest wall reconstruction after traumatic sternal and/or rib fractures, no study so far has examined the efficacy of this treatment. We report a single-center retrospective cohort study, examining outcomes using ciNPT following rib and sternal fixation in trauma patients. Data on 71 patients who suffered from rib and/or sternal fractures, requiring surgical intervention, were collected over a time period of three years, from December 2016 to December 2019. The patient population was 66% male (47/71), had a mean age of 63.3 years (range 23-90 years old), and suffered from injuries related to motor vehicle or motorcycle accidents (45/71, 63%). Among the patients treated with ciNPT, none developed signs of SSIs during their initial hospitalization or within two months post-discharge follow-up. Negative pressure therapy is an effective wound care management system for preventing infections in closed-incision sites following chest wall reconstruction.
Collapse
Affiliation(s)
- Daud Lodin
- Surgery, Florida Atlantic University Charles E. Schmidt College of Medicine, Boca Raton, USA
| | - Taylor Florio
- Surgery, St. George's University School of Medicine, St. George's, GRD
| | - Thomas Genuit
- Surgery, Florida Atlantic University Charles E. Schmidt College of Medicine, Boca Raton, USA
| | - Nir Hus
- Surgery, Delray Medical Center, Delray Beach, USA
- Surgery, Florida Atlantic University Charles E. Schmidt College of Medicine, Boca Raton, USA
| |
Collapse
|
32
|
Marulli G, De Iaco G, Ferrigno P, De Palma A, Quercia R, Brascia D, Schiavon M, Mammana M, Rea F. Sternochondral replacement: use of cadaveric allograft for the reconstruction of anterior chest wall. J Thorac Dis 2020; 12:3-9. [PMID: 32055417 DOI: 10.21037/jtd.2019.07.82] [Citation(s) in RCA: 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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Background Sternum may be involved by different diseases such as trauma, infection after cardiac surgery, tumors (primary and secondary) or chest wall deformities. Surgical excision with a safety margin is the primary goal after sternal resection for tumors, prevention of respiratory impairment due to flail chest and deformity and protection of surrounding organs are other important aims. Various techniques and materials have been used for this operation. We describe the use of cadaveric sternal allograft to reconstruct the chest wall in fourteen patients. Methods Between October 2008 and February 2017, five males and nine females underwent surgical procedure because of primary sternal neoplasm, single-site metastatic disease, neuroendocrine thymic carcinoma and sternal dehiscence after cardiac surgery. Results Fourteen sternectomy were undertaken. A muscle flap of pectoralis major was prepared to cover the graft in 9 patients. Adjuvant chemotherapy and radiotherapy were performed after surgery in three patients. No postoperative complications happened in 11 cases (84.6%). One (7.1%) patient died 9 days after surgery because of pulmonary embolism. Two patients (15.4%) had complications: one presented fever caused by systemic candidiasis and one had a muscle flap bleeding. Hospitalization median time was 11 days (range, 6-31 days). At follow up, 7 patients were alive in absence of disease, 1 patient is alive with recurrence, 6 patients died but nor infection neither rejection of the graft happened. No respiratory impairment or flail chest were registered in any patients. Conclusions This technique for sternal replacement in our experience can be considered safe with long term results, providing optimal chest wall stability. The allograft resulted well-tolerated permitting an optimal graft integration in the host.
Collapse
Affiliation(s)
| | - Giulia De Iaco
- Thoracic Surgery Unit, University Hospital of Bari, Bari, Italy
| | - Pia Ferrigno
- Thoracic Surgery Unit, University Hospital of Padova, Padova, Italy
| | - Angela De Palma
- Thoracic Surgery Unit, University Hospital of Bari, Bari, Italy
| | - Rosatea Quercia
- Thoracic Surgery Unit, University Hospital of Bari, Bari, Italy
| | - Debora Brascia
- Thoracic Surgery Unit, University Hospital of Bari, Bari, Italy
| | - Marco Schiavon
- Thoracic Surgery Unit, University Hospital of Padova, Padova, Italy
| | - Marco Mammana
- Thoracic Surgery Unit, University Hospital of Padova, Padova, Italy
| | - Federico Rea
- Thoracic Surgery Unit, University Hospital of Padova, Padova, Italy
| |
Collapse
|
33
|
Yong H, Chen Q, Yoo E, Lau S, Vazquez W, Shaul D, Sydorak R. How Does Resident Participation Alter the Outcome of Surgery for Pectus Excavatum? J Surg Educ 2020; 77:150-157. [PMID: 31462386 DOI: 10.1016/j.jsurg.2019.07.020] [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] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/09/2019] [Revised: 06/30/2019] [Accepted: 07/27/2019] [Indexed: 06/10/2023]
Abstract
BACKGROUND General surgery resident participation in the operating room is critical in training the next generation of surgeons. As of yet, the impact of resident participation on outcomes of surgery for pectus excavatum and many complex subspecialty operations has not been well studied. METHODS A multi-institutional retrospective study of patients undergoing operative repair for pectus excavatum was performed. All relevant data were analyzed (IRB 11144). RESULTS Two hundred and fourteen patients underwent operative correction (195 Nuss, 19 Ravitch). There were 185 males. Average age at repair was 14.7 years with a Haller index of 4.5. Average surgery time was 144 minutes (57-255) for the Nuss procedure and 263 minutes (141-373) for the Ravitch procedure. The presence of a second pediatric surgeon reduced the surgery time from 170 to 135 minutes (p < 0.01) and the presence of residents increased the time from 129 to 155 minutes (p < 0.01) for the Nuss procedure. One hundred and fifty patients had a single bar and 57 patients had 2 bars (28%). Average length of stay was 4.96 days (3-11). Long-term follow-up averaged 1737 days (42-3894). There were few complications and no difference in complication rate or length of stay between groups. Ninety nine percent of patients deemed the repair excellent and no patients required revision. CONCLUSIONS Resident participation increases operative time, but with no demonstrable effect on hospital stay or long-term outcomes. Complication rates are low regardless of operating team composition. Thus, continuing to allow resident involvement, especially in subspecialty operations such as the Nuss and Ravitch procedures, may be worthwhile for resident education and surgical experience.
Collapse
Affiliation(s)
- Holly Yong
- Kaiser Permanente Los Angeles Medical Center, Los Angeles, California.
| | - Qiaoling Chen
- Kaiser Permanente Los Angeles Medical Center, Los Angeles, California
| | - Edward Yoo
- Kaiser Permanente Los Angeles Medical Center, Los Angeles, California
| | - Stanley Lau
- Kaiser Permanente Los Angeles Medical Center, Los Angeles, California
| | - Walter Vazquez
- Kaiser Permanente Los Angeles Medical Center, Los Angeles, California
| | - Donald Shaul
- Kaiser Permanente Los Angeles Medical Center, Los Angeles, California
| | - Roman Sydorak
- Kaiser Permanente Los Angeles Medical Center, Los Angeles, California
| |
Collapse
|
34
|
Sandri A, Donati G, Blanc CD, Nigra VA, Gagliasso M, Barmasse R. Anterior chest wall resection and sternal body wedge for primary chest wall tumour: reconstruction technique with biological meshes and titanium plates. J Thorac Dis 2020; 12:17-21. [PMID: 32055419 DOI: 10.21037/jtd.2019.06.45] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Chest wall tumours are heterogeneous neoplasms, either primary or metastatic, with a malignancy rate of 50%. Surgical resection is one of the mainstays of the treatment, however, chest wall resections can be particularly challenging depending onto the resection size, site and patient habitus. The surgical strategy should be carefully analysed preoperatively, keeping in mind the need of an oncological radical resection (R0) in accordance to the reconstruction principles elicited by le Roux and Sherma since 1983, which include restoring the chest wall rigidity, preserving pulmonary mechanics, protect the intrathoracic organs, avoiding paradox movements of the chest cavity and, possibly, to reduce the thoracic deformity. In this context, we herewith report our surgical reconstruction technique following an anterior chest wall resection and sternal body wedge for a primary chest wall tumour (chondrosarcoma).
Collapse
Affiliation(s)
- Alberto Sandri
- Unit of Thoracic Surgery, San Luigi Gonzaga Hospital, University of Turin, Orbassano, Turin, Italy
| | | | | | - Victor Auguste Nigra
- Department of Thoracic Surgery, Azienda Ospedaliera Universitaria Città della Salute e della Scienza di Torino, University of Turin, Torino, Italy
| | - Matteo Gagliasso
- Unit of Thoracic Surgery, San Luigi Gonzaga Hospital, University of Turin, Orbassano, Turin, Italy
| | | |
Collapse
|
35
|
Zanchetta F, Borg M, Troisi L. Reconstruction of a deep sternal wound with exposed pericardium using an IMAP propeller flap: A case report. Clin Case Rep 2019; 7:2371-2374. [PMID: 31893061 PMCID: PMC6935634 DOI: 10.1002/ccr3.2492] [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: 06/09/2019] [Accepted: 08/31/2019] [Indexed: 11/17/2022] Open
Abstract
The results of this case suggest that the IMAP propeller flap may be a viable and safe option for deep sternal wound reconstruction with minimal donor-site morbidity.
Collapse
Affiliation(s)
- Francesco Zanchetta
- Department of Plastic and Reconstructive SurgerySalisbury District HospitalSalisbury NHS Foundation TrustSalisburyUK
- Plastic Reconstructive and Aesthetic Surgery UnitUniversity of MessinaPoliclinico “G. Martino”MessinaItaly
| | - Matthew Borg
- Department of Plastic and Reconstructive SurgerySalisbury District HospitalSalisbury NHS Foundation TrustSalisburyUK
- Plastic Surgery and Burns UnitMater Dei HospitalL‐ImsidaMalta
| | - Luigi Troisi
- Department of Plastic and Reconstructive SurgerySalisbury District HospitalSalisbury NHS Foundation TrustSalisburyUK
- Orthopaedic DepartmentSouthampton General HospitalUniversity Hospital Southampton NHS Foundation TrustSouthamptonUK
- University Department of Hand Surgery & RehabilitationSan Giuseppe HospitalIRCCS MultiMedicaMilan UniversityMilanItaly
| |
Collapse
|
36
|
Abstract
Tridimensional custom-made titanium-printed prosthesis have gained certain relevance as an alternative for chest wall reconstruction although different limitations such as uncomfortable intraoperative placement, long manufacturing time or high costs hinder its use when compared to other standard devices. Trying to overcome these problems, we developed a new model of customized modular titanium-printed prosthesis (CM-TPP) for chest wall reconstruction after breast metastasis resection that seems to offer some advantages over other custom-made reconstructive devices.
Collapse
Affiliation(s)
- José L Aranda
- Thoracic Surgery Department, Salamanca University Hospital, Faculty of Medicine, University of Salamanca, Salamanca, Spain
| | - Nuria Novoa
- Thoracic Surgery Department, Salamanca University Hospital, Faculty of Medicine, University of Salamanca, Salamanca, Spain
| | - Marcelo F Jiménez
- Thoracic Surgery Department, Salamanca University Hospital, Faculty of Medicine, University of Salamanca, Salamanca, Spain
| |
Collapse
|
37
|
Tamburini N, Grossi W, Sanna S, Campisi A, Londero F, Maniscalco P, Dolci G, Quarantotto F, Daddi N, Morelli A, Cavallesco G, Dell'Amore A. Chest wall reconstruction using a new titanium mesh: a multicenters experience. J Thorac Dis 2019; 11:3459-3466. [PMID: 31559051 DOI: 10.21037/jtd.2019.07.74] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Abstract
Background Many new surgical techniques and materials have been introduced in the last decade for chest wall reconstruction or stabilization with the purpose of improving the incorporation, maintaining chest wall stability with reduction of infections. However, none of them are yet considered a gold standard procedure. The aim of this work is to evaluate the initial experience using a new titanium mesh for chest wall reconstruction in four Italian Thoracic Surgery Departments. Methods A review was performed of all patients undergoing chest wall reconstruction using a new titanium mesh between January 2014 and September 2018. Surgical indications, the location and size of the chest wall defect, intraoperative variables and postoperative complications were analyzed. Results A total of 26 consecutive patients were included. The most common indications for surgery were primary or secondary chest wall tumors (38%) followed by lung cancer invading chest wall (31%). The most common localization of chest wall defect was anterolateral (46%). Sternal reconstruction was required in 3 patients (12%). The average size of the defect was 9.3×7.8 cm. The median number of resected ribs was 3.6. No perioperative deaths occurred. Mean hospital stay was 11.9 days. Overall morbidity was 19%. One failure of reconstruction (4%) was reported during follow up. Conclusions In our early clinical experience chest wall reconstruction using titanium mesh can be performed as a safe and effective surgical procedure. This mesh has excellent biomechanical characteristics between rigid and malleable materials, it's easy to trim and fix for optimal adaptation without necessity of dedicated instruments. The early and mid-term results are satisfactory with low incidence of complications related to the titanium mesh implant.
Collapse
Affiliation(s)
- Nicola Tamburini
- Department of Morphology, Experimental Medicine and Surgery, Section of Chirurgia 1, Sant'Anna Hospital, University of Ferrara, Ferrara, Italy
| | - William Grossi
- Department of CardioThoracic Surgery, Santa Maria della Misericordia Hospital, Udine, Italy
| | - Stefano Sanna
- Thoracic Surgery Unit, G.B. Morgagni Hospital, Forlì, Italy
| | - Alessio Campisi
- Department of CardioThoracic Surgery, S.Orsola Malpighi University Hospital, Bologna, Italy
| | - Francesco Londero
- Department of CardioThoracic Surgery, Santa Maria della Misericordia Hospital, Udine, Italy
| | - Pio Maniscalco
- Department of Morphology, Experimental Medicine and Surgery, Section of Chirurgia 1, Sant'Anna Hospital, University of Ferrara, Ferrara, Italy
| | - Giampiero Dolci
- Department of CardioThoracic Surgery, S.Orsola Malpighi University Hospital, Bologna, Italy
| | - Francesco Quarantotto
- Department of Morphology, Experimental Medicine and Surgery, Section of Chirurgia 1, Sant'Anna Hospital, University of Ferrara, Ferrara, Italy
| | - Niccolò Daddi
- Department of CardioThoracic Surgery, S.Orsola Malpighi University Hospital, Bologna, Italy
| | - Angelo Morelli
- Department of CardioThoracic Surgery, Santa Maria della Misericordia Hospital, Udine, Italy
| | - Giorgio Cavallesco
- Department of Morphology, Experimental Medicine and Surgery, Section of Chirurgia 1, Sant'Anna Hospital, University of Ferrara, Ferrara, Italy
| | - Andrea Dell'Amore
- Department of CardioThoracic Surgery, S.Orsola Malpighi University Hospital, Bologna, Italy
| |
Collapse
|
38
|
Bergquist JR, Morris JM, Matsumoto JM, Schiller HJ, Kim BD. 3D printed modeling contributes to reconstruction of complex chest wall instability. Trauma Case Rep 2019; 22:100218. [PMID: 31249855 PMCID: PMC6584793 DOI: 10.1016/j.tcr.2019.100218] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [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: 06/16/2019] [Indexed: 11/30/2022] Open
Abstract
Background Three-dimensional printed models are increasingly used in many fields including medicine and surgery, but their use in the planning and execution of complex chest wall reconstruction has not been adequately described. In cases of non-union or prior attempts at chest wall reconstruction which have failed, there can be substantial deviations from expected chest wall anatomy. We report a novel technique for pre-operative planning and surgical execution of complex chest wall reconstruction, assisted by 3D printing. Our objective was to utilize 3-D volumetric modeling coupled with 3-D printing to produce patient-specific models for chest wall reconstruction in complex cases. Methods Soft tissue reconstruction 0.75 mm slice thickness computed tomography (CT) imaging data was loaded into medical CAD software for segmentation. Lung, muscle, foreign bodies, and bony structureswere separated due to the differences in density between them. The 3D volumetric mesh was then quality checked and stereolithography files (STL) were made which were able to be utilized by the 3D printer. The STL files were exported to a Objet 500 material jetting printer that utilized several UV light cured photopolymers. Results As an example case, we discuss a 55 year old male who underwent resuscitative thoracotomy. In the early post-operative period, he developed a pulmonary hernia in the 6th intercostal space, repaired with wire cerclage reapproximation of ribs. He developed a symptomatic mobile chest wall at the site of prior repair with additional concern for dissociated anterior cartilage. In preparation for operative repair, a 3D printed model was created, demonstrating fractured cartilage anteriorly as well a saw effect through the six and seventh ribs. An additional model was created using the normal ribs from the right side in mirror image reflection to quantify the degree and precise geometry of mal-alignment to the left chest. These models were then utilized to determine the operative approach via a thoracotomy incision to remove the cerclage wires, followed by parasternal incision, reduction and plating of the sternocostal non-union bursa Rib non-unions were plate stabilized. Repeat imaging in follow-up has demonstrated continued appropriate alignment and the patient reported improvement in his symptoms. Conclusion At present, the cost of 3-D printing remains substantial, but given the improved planning in complex cases, this cost may be recaptured in the reduction of operative time and improved outcomes with reduced re-operation rates. We believe that the early adoption of this technology by surgeons can help improve surgical quality and provide enhanced individualized patient care. These patient-specific models facilitate identification of features which are often not detected with standard 3-D reconstructed CT rendering. Centers should pursue the integration of 3-D printed models into their practice and active collaborations between surgeons and modeling experts should be sought at every available opportunity.
Collapse
Affiliation(s)
- John R Bergquist
- Mayo Clinic Rochester, Department of Surgery, United States of America
| | - Jonathan M Morris
- Mayo Clinic Rochester, Department of Radiology, United States of America
| | - Jane M Matsumoto
- Mayo Clinic Rochester, Department of Radiology, United States of America
| | - Henry J Schiller
- Mayo Clinic Rochester, Department of Surgery, United States of America
| | - Brian D Kim
- Mayo Clinic Rochester, Department of Surgery, United States of America
| |
Collapse
|
39
|
O'Keeffe N, Concannon E, Stanley A, Dockery P, McInerney N, Kelly JL. Cadaveric evaluation of sternal reconstruction using the pectoralis muscle flap. ANZ J Surg 2019; 89:945-949. [PMID: 31155817 DOI: 10.1111/ans.15268] [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: 11/23/2018] [Revised: 02/06/2019] [Accepted: 04/03/2019] [Indexed: 01/12/2023]
Abstract
BACKGROUND Deep sternal wound infection is a significant complication of open cardiac surgery associated with increased mortality and morbidity. The use of muscle flaps, such as the pectoralis major advancement flap, in deep sternal wound infection reconstruction reduces hospital stay and mortality. However, the lower end of the sternum is remote from the vascular supply and cover is therefore problematic in many cases. METHODS This study aimed to determine the distance (cm) and surface area (cm2 ) of sternum covered when the pectoralis major muscle is sequentially dissected from the sternocostal origin and humeral insertion using 10 cadaveric specimens. RESULTS The largest proportion of sternum was covered when both the origin and insertion were divided, allowing the flap to be islanded on its vascular pedicle. There was a statistically significant difference when the pectoralis major was divided from the origin and insertion compared to division of the origin alone (P < 0.01). The average area covered with sternocostal origin division alone was 55.43 cm2 compared to 85.36 cm2 after division of both the origin and insertion. CONCLUSION Division of both the sternocostal origin and humeral insertion of the pectoralis major muscle represents an effective means to increase sternal coverage. This study describes the average distance and area covered by sliding pectoralis major muscle advancement flaps. These measurements could better inform plastic surgeons when evaluating reconstructive options in sternal defects.
Collapse
Affiliation(s)
- Nick O'Keeffe
- Department of Plastic and Reconstructive Surgery, University Hospital Galway, Galway, Ireland
| | - Elizabeth Concannon
- Department of Plastic and Reconstructive Surgery, University Hospital Galway, Galway, Ireland
| | - Alanna Stanley
- Department of Anatomy, National University of Ireland Galway, Galway, Ireland
| | - Peter Dockery
- Department of Anatomy, National University of Ireland Galway, Galway, Ireland
| | - Niall McInerney
- Department of Plastic and Reconstructive Surgery, University Hospital Galway, Galway, Ireland
| | - Jack L Kelly
- Department of Plastic and Reconstructive Surgery, University Hospital Galway, Galway, Ireland
| |
Collapse
|
40
|
Romolo H, Andinata B, Aisiyah D, Budiluhur A. Sternal reconstruction for primary sternal tumor in a post-coronary artery bypass grafting surgery patient. SAGE Open Med Case Rep 2019; 7:2050313X19847801. [PMID: 31105953 PMCID: PMC6503599 DOI: 10.1177/2050313x19847801] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2018] [Accepted: 04/10/2019] [Indexed: 11/23/2022] Open
Abstract
Epithelioid sarcoma is a very rare tumor, comprising less than 1% of all soft
tissue sarcoma. Due to its rarity and benign presentation, it is often
misdiagnosed. We present a case of epithelioid sarcoma mimicking coronary artery
bypass grafting post-operative keloid. Current literature suggests the
management for epithelioid sarcoma to include surgery and adjuvant radiation. In
this patient, chest wall reconstruction was done using titanium mesh and muscle
flaps. Post-operative radiation was given and computerized tomography scan was
evaluated 3 months after reconstruction.
Collapse
Affiliation(s)
- Harvey Romolo
- Department of Cardiac, Vascular and Thoracic Surgery, Dharmais National Cancer Center, DKI Jakarta, Indonesia
| | - Bob Andinata
- Department of Oncologic Surgery, Dharmais National Cancer Center, DKI Jakarta, Indonesia
| | - Dewi Aisiyah
- Department of Plastic and Reconstruction Surgery, Dharmais National Cancer Center, DKI Jakarta, Indonesia
| | - Ati Budiluhur
- Department of Cardiac, Vascular and Thoracic Surgery, Dharmais National Cancer Center, DKI Jakarta, Indonesia
| |
Collapse
|
41
|
Wang B, Guo Y, Tang J, Yu F. Three-dimensional custom-made carbon-fiber prosthesis for sternal reconstruction after sarcoma resection. Thorac Cancer 2019; 10:1500-1502. [PMID: 31094079 PMCID: PMC6558465 DOI: 10.1111/1759-7714.13084] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [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: 03/22/2019] [Revised: 04/08/2019] [Accepted: 04/11/2019] [Indexed: 01/23/2023] Open
Abstract
Radical resection is the preferred therapy for primary malignant sternal tumors. Sternal reconstruction is required to guarantee the best preservation of respiratory mechanics, and adequate mediastinal protection and acceptable cosmetic results after extensive tumor resection. A wide variety of methods and materials have been described for sternal reconstruction. Titanium implants are preferred by many surgeons because of their optimal features. However, the smooth surface of the metal prostheses does not facilitate the inward growth of the tissue, and the high density of metal can block the X‐ray and cause adverse effects on postoperative imaging and radiotherapy. Therefore, in this article we present a case of sternal reconstruction by means of a three dimensional (3D) custom‐made carbon‐fiber prosthesis following extensive resection of a sternal synovial sarcoma. The microporous structure on the surface of the carbon fiber composite material facilitates the inward growth of the tissue. Low density (1.5 g/cm3) of carbon‐fiber implant will not block the X‐ray and eliminates the adverse effects caused by metal material of postoperative imaging and radiotherapy. The 3D custom‐made carbon‐fiber prosthesis matched the thoracic defect perfectly and the chest wall reconstruction was stable for more than 24 months.
Collapse
Affiliation(s)
- Bin Wang
- Department of Thoracic Surgery, The Second Xiangya Hospital of Central South University, Hunan, China
| | - Yuanwei Guo
- Center for Clinical Pathology, Affiliated the First People's Hospital of Chenzhou, University of South China, Hunan, China
| | - Jingqun Tang
- Department of Thoracic Surgery, The Second Xiangya Hospital of Central South University, Hunan, China
| | - Fenglei Yu
- Department of Thoracic Surgery, The Second Xiangya Hospital of Central South University, Hunan, China
| |
Collapse
|
42
|
Abstract
Radiation therapy can have adverse effects on normal tissue and cause chronic ulcers. The purpose of this study was to compare breast cancer patients who underwent single-stage reconstruction with patients who underwent 2-stage reconstruction for chronic radiation-induced necrotic ulcers of the chest wall.This retrospective study comprised of 50 patients with chronic radiation-induced chest wall ulcers who underwent chest wall reconstruction in our hospital between January 2002 and January 2016. All patients developed ulcers after undergoing breast cancer surgery, followed by radiation therapy. These patients were divided into 2 groups: group A, patients who underwent debridement and reconstruction with tissue flaps simultaneously in a single-stage procedure; group B, patients who underwent debridement and omentum majus tamping in the 1st stage, followed by surgical reconstruction with skin grafting or flap transfer 2 weeks later. The postoperative complications and outcomes were evaluated and compared.These patients were followed up for 48 to 55 months (mean: 50 months), and overall survival was 98%. One patient in group A died of septicemia 5 days after the operation. Six patients in group A developed flap infection, among which 4 patients progressed to flap necrosis (group A: 6/25 vs group B: 0/25; P = .000).Compared to single-stage reconstruction, surgical reconstruction in 2 stages was safer and more effective in treating chronic radiation-induced ulcers of the chest wall, and is associated with fewer postoperative complications. The omentum majus flap was the most ideal tissue for the repair of these defects.
Collapse
Affiliation(s)
| | - Yixin Zhang
- Department of Plastic and Reconstructive Surgery, Shanghai Ninth People's Hospital Affiliated to Shanghai Jiaotong University, Shanghai, China
| |
Collapse
|
43
|
Elkhouly AG, Cervelli V, Sanese G, Pompeo E. Hump-like giant desmoid tumor of the chest: a postresectional reconstruction challenge. AME Case Rep 2018; 1:6. [PMID: 30263993 DOI: 10.21037/acr.2017.11.01] [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: 10/13/2017] [Accepted: 10/31/2017] [Indexed: 11/06/2022]
Abstract
Desmoid tumors (DT) are rare neoplasms with unknown etiology arising from musculoaponeurotic structures. Chest wall localization is uncommon and has been associated with high recurrence rate unless radical resection with negative margins is carried out. Postresectional reconstruction can be challenging in presence of giant lesions and might require adoption of complex reconstruction methods including use of well vascularized muscle flaps. We present a case of giant hump-like recurrent chest wall DT, which was radically resected following placement of multiple subcutaneous silicon tissue expanders, to gain redundant skin, which eventually allowed in conjunction with two transposition, cutaneous-adipose flaps, harvested from the upper gluteal region, an optimal reconstruction of the large postresectional defect.
Collapse
Affiliation(s)
- Ahmed G Elkhouly
- Department of Cardiothoracic Surgery, Faculty of Medicine, Tanta University, Tanta, Egypt
| | - Valerio Cervelli
- Department of Plastic and Reconstructive Surgery, Policlinico Tor Vergata University, Rome, Italy
| | - Giuseppe Sanese
- Department of Plastic and Reconstructive Surgery, Policlinico Tor Vergata University, Rome, Italy
| | - Eugenio Pompeo
- Department of Thoracic Surgery, Policlinico Tor Vergata University, Rome, Italy
| |
Collapse
|
44
|
D'Amico G, Manfredi R, Nita G, Poletti P, Milesi L, Livraghi L, Poletti E, Verga M, Robotti E, Ansaloni L. Reconstruction of the Thoracic Wall With Biologic Mesh After Resection for Chest Wall Tumors: A Presentation of a Case Series and Original Technique. Surg Innov 2017; 25:28-36. [PMID: 29251555 DOI: 10.1177/1553350617745954] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [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: 01/16/2023]
Abstract
INTRODUCTION Synthetic materials have traditionally been used for tissue reconstruction in thoracic surgery. New biomaterials have been tested in other areas of surgery with good results. Non-cross-linked swine dermal collagen prosthesis has been used to reconstruct musculofascial defects in the trunk with low infection and herniation rate. MATERIAL AND METHODS Retrospectively, we analyze our initial experience of chest wall reconstruction on large defects using a non-cross-linked swine dermal collagen matrix mesh with a thickness of 1.4 mm. A total of 11 consecutive patients were included. Preoperative, intraoperative, and postoperative data were taken into consideration. RESULTS Eleven sarcoma patients with a mean age of 58.25 ± 12.9 years underwent chest wall resections. Complete thoracic wall defects ranged from 6 · 9 to 16 · 25 cm in size. In all cases, we used a porcine collagen matrix mesh, and in all patients, it was covered by transposition of myocutaneous flap. The complications occurred in 5 (45%) patients, 1 (9%) pneumonia, 1 atrial fibrillation (9%), and 3 (27%) wound healing difficulty because of hematoma or infection. There was no respiratory impairment, and the pulmonary function (total lung capacity, vital capacity, and forced expiratory volume in 1 second) was not statistically different before and after surgery. The 30-day mortality was 0%, 1-year mortality and 2-year mortality was 27.2%. The collagen material resulted in a durable and good to excellent chest wall stability in clinical follow-ups, and on computer tomography scans spanning over 2 years. CONCLUSION Non-cross-linked acellular porcine dermal collagen matrix is a feasible and reliable biological patch material for reconstruction of the thoracic wall. Excellent wound healing, long-term stability, low complication, and good pulmonary function are achieved even in large defects.
Collapse
|
45
|
Pechetov AA, Esakov YS, Makov MA, Okonskaya DE, Basylyuk AV, Khlan TN. [Laparoscopic-assisted harvesting of omental flap in chest wall reconstruction for deep sternal wound infection]. Khirurgiia (Mosk) 2017:18-23. [PMID: 28805774 DOI: 10.17116/hirurgia2017818-23] [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] [Indexed: 06/07/2023]
Abstract
AIM To present an experience of laparoscopic-assisted harvesting of omental flap in chest wall reconstruction for deep sternal wound infection. MATERIAL AND METHODS It was made a prospective analysis of 14 patients aged 39-85 years after laparoscopic-assisted harvesting of omental flap in chest wall reconstruction for the period December 2014 - November 2016. Men/women ratio was 10/4. All patients had deep sternal wound infection grade IV (Oakley-Wright classification). RESULTS Postoperative complications were observed in 2 (14.3%) of 14 (95% CI: 4.0-39.9%) cases that did not require re-operation. There were no 30-day postoperative mortality and significant complications as acute intestinal obstruction, postoperative ventral herniation and transplant rejection. Mean postoperative hospital-stay was 10.5 (9; 13) days. CONCLUSION Laparoscopic-assisted harvesting of omental flap is safe method for chest wall reconstruction in patients with severe sternal wound infection associated with soft tissue deficiency and high risk of local complications (bleeding, etc.). Laparoscopy significantly reduces incidence of postoperative complications after omental flap transposition and is feasible in majority of patients.
Collapse
Affiliation(s)
- A A Pechetov
- A.V. Vishnevsky Surgery Institute of Health Ministry of the Russian Federation, Moscow, Russia
| | - Yu S Esakov
- A.V. Vishnevsky Surgery Institute of Health Ministry of the Russian Federation, Moscow, Russia
| | - M A Makov
- A.V. Vishnevsky Surgery Institute of Health Ministry of the Russian Federation, Moscow, Russia
| | - D E Okonskaya
- A.V. Vishnevsky Surgery Institute of Health Ministry of the Russian Federation, Moscow, Russia
| | - A V Basylyuk
- A.V. Vishnevsky Surgery Institute of Health Ministry of the Russian Federation, Moscow, Russia
| | - T N Khlan
- A.V. Vishnevsky Surgery Institute of Health Ministry of the Russian Federation, Moscow, Russia
| |
Collapse
|
46
|
Abstract
Chest wall (CW) involvement occurs in approximately 5% of all primary lung neoplasms. According to the most recent TNM classification, lung tumors invading CW are classified as T3, and they represent approximately 45% of all T3 lung cancers. The most common clinical symptom at presentation is chest pain (>60%), which is highly specific of CW infiltration (>90%). Dyspnoea and hemoptysis are also described, especially in case of large lesions. A realistic chance to cure locally advanced tumors invading CW is a surgical resection, consisting in the excision of the primary lung cancer along with the involved CW (sometimes an "en-bloc" resection) and an appropriate lymph-nodal dissection. However, such patients are at high-risk of facing postoperative complications; prognosis mainly depends on: (I) the completeness of resection; and (II) the lymph-nodal involvement. Hence, due to these reasons (incidence, symptoms, prognosis, post-operative complications), such category of patients are to be carefully assessed preoperatively and if deemed practicable, surgery should be taken into consideration. In this view, the aim of this paper is to critically review the most recent series of lung tumors invading the CW, with a particular focus on patients' preoperative evaluation, surgical techniques, postoperative complications and overall outcome.
Collapse
Affiliation(s)
- Pier Luigi Filosso
- Department of Thoracic Surgery, University of Torino Italy, Torino, Italy
| | - Alberto Sandri
- Department of Thoracic Surgery, University of Torino Italy, Torino, Italy
| | - Francesco Guerrera
- Department of Thoracic Surgery, University of Torino Italy, Torino, Italy
| | - Paolo Solidoro
- San Giovanni Battista Hospital, Service of Pulmonology, Via Genova, Torino, Italy
| | - Giulia Bora
- Department of Thoracic Surgery, University of Torino Italy, Torino, Italy
| | - Paraskevas Lyberis
- Department of Thoracic Surgery, University of Torino Italy, Torino, Italy
| | - Enrico Ruffini
- Department of Thoracic Surgery, University of Torino Italy, Torino, Italy
| | - Alberto Oliaro
- Department of Thoracic Surgery, University of Torino Italy, Torino, Italy
| |
Collapse
|
47
|
Simal I, García-Casillas MA, Cerdá JA, Riquelme Ó, Lorca-García C, Pérez-Egido L, Fernández-Bautista B, Torre MDL, de Agustín JC. Three-Dimensional Custom-Made Titanium Ribs for Reconstruction of a Large Chest Wall Defect. European J Pediatr Surg Rep 2016; 4:26-30. [PMID: 28018805 PMCID: PMC5177554 DOI: 10.1055/s-0036-1593738] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [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: 07/17/2016] [Accepted: 09/03/2016] [Indexed: 01/30/2023] Open
Abstract
Reconstruction of large chest wall defects always demand surgeons of having lots of means available (both materials and resourceful) to apply a cover to chest wall defects which can range from a few centimeters to the lack of a few entire ribs. In this study, we present the case of a teenager who suffered from a complete resection of three ribs because of Ewing sarcoma dependent on the sixth rib. Given the size of the defect, a multidisciplinary approach was chosen to provide rigid and soft tissue coverage and minimal functional and aesthetic impact. Custom-made titanium implants were designed based on three-dimensional computed tomography scan reconstruction. The surgical specimen via a left lateral thoracotomy (fifth, sixth, and seventh entire ribs) was resected, leaving a defect of 35 × 12 × 6 cm. A Gore-Tex patch (W. L. Gore & Associates, Arizona, United States) was placed and, after that, the implants were anchored to the posterior fragment of the healthy ribs and to the costal cartilage anteriorly. Finally, the surgical site was covered with a latissimus dorsi flap. The postoperative course was uneventful. After 9 months of follow-up, the patient has full mobility. This case shows that the implant of custom-made ribs, combined with other techniques, is a good surgical choice for reconstruction of large chest wall defects. The implant of custom-made ribs, combined with other techniques, is a good surgical choice for reconstruction of large chest wall defects.
Collapse
Affiliation(s)
- Isabel Simal
- Department of Pediatric Surgery, Gregorio Marañon University Hospital, Madrid, Spain
| | | | - Julio Arturo Cerdá
- Department of Pediatric Surgery, Gregorio Marañon University Hospital, Madrid, Spain
| | - Óscar Riquelme
- Department of Pediatric Traumatology and Orthopedics, Gregorio Marañon University Hospital, Madrid, Spain
| | - Concepción Lorca-García
- Department of Pediatric Plastic Surgery, Gregorio Marañon University Hospital, Madrid, Spain
| | - Laura Pérez-Egido
- Department of Pediatric Surgery, Gregorio Marañon University Hospital, Madrid, Spain
| | | | - Manuel de la Torre
- Department of Pediatric Surgery, Gregorio Marañon University Hospital, Madrid, Spain
| | | |
Collapse
|
48
|
Abstract
Reconstruction of chest wall tumor is very important link of chest wall tumor resection. Many implants have been reported to be used to reconstruct the chest wall, such as steelwire, titanium mesh and polypropylene mesh. It is really hard for clinicians to decide which implant is the best one to replace the chest wall. We herein report a 68-year-old man who had underwent a chest wall reconstruction with a hernia repair piece and a Dacron hernia repair piece. The patient has maintained an excellent cosmetic and functional outcome since surgery, which proves that the hernia piece still has its place in reconstruction of chest wall.
Collapse
Affiliation(s)
- Yimin Wu
- Department of Thoracic Surgery, the Second Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou 310009, China
| | - Guofei Zhang
- Department of Thoracic Surgery, the Second Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou 310009, China
| | - Zhouyu Zhu
- Department of Thoracic Surgery, the Second Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou 310009, China
| | - Ying Chai
- Department of Thoracic Surgery, the Second Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou 310009, China
| |
Collapse
|
49
|
Abstract
Due to high rates of complications, chest wall resection and reconstruction is a high risk procedure when large size of resection is required. Many different prosthetic materials have been used with similar results. Recently, thanks to the new advances in technology, personalized reconstruction have been possible with specific custom-made prosthesis. Nevertheless, they all generate certain amount of stiffness in thoracic motion because of his rigidity. In this report, we present a forward step in prosthesis design based on tridimensional titanium-printed technology. An exact copy of the resected chest wall was made, even endowing simulated sternochondral articulations, to achieve the most exact adaptation and best functional results, with a view to minimize postoperative complications. This novel design, may constitute an important step towards the improvement of the functional postoperative outcomes compared to the other prosthesis, on the hope, to reduce postoperative complications.
Collapse
Affiliation(s)
- Javier Aragón
- Department of Thoracic Surgery, Asturias University Central Hospital, Asturias, Spain
| | - Itzell Pérez Méndez
- Department of Thoracic Surgery, Asturias University Central Hospital, Asturias, Spain
| |
Collapse
|
50
|
Foroulis CN, Kleontas AD, Tagarakis G, Nana C, Alexiou I, Grosomanidis V, Tossios P, Papadaki E, Kioumis I, Baka S, Zarogoulidis P, Anastasiadis K. Massive chest wall resection and reconstruction for malignant disease. Onco Targets Ther 2016; 9:2349-58. [PMID: 27143930 PMCID: PMC4846065 DOI: 10.2147/ott.s101615] [Citation(s) in RCA: 10] [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] [Indexed: 01/17/2023] Open
Abstract
Objective Malignant chest wall tumors are rare neoplasms. Resection with wide-free margins is an important prognostic factor, and massive chest wall resection and reconstruction are often necessary. A recent case series of 20 consecutive patients is reported in order to find any possible correlation between tumor histology, extent of resection, type of reconstruction, and adjuvant treatment with short- and long-term outcomes. Methods Twenty patients were submitted to chest wall resection and reconstruction for malignant chest wall neoplasms between 2006 and 2014. The mean age (ten males) was 59±4 years. The size and histology of the tumor, the technique of reconstruction, and the short- and long-term follow-up records were noted. Results The median maximum diameter of tumors was 10 cm (5.4–32 cm). Subtotal sternal resection was performed in nine cases, and the resection of multiple ribs was performed in eleven cases. The median area of chest wall defect was 108 cm2 (60–340 cm2). Histology revealed soft tissue, bone, and cartilage sarcomas in 16 cases (80%), most of them chondrosarcomas. The rest of the tumors was metastatic tumors in two cases and localized malignant pleural mesothelioma and non-Hodgkin lymphoma in one case. The chest wall defect was reconstructed by using the “sandwich technique” (propylene mesh/methyl methacrylate/propylene mesh) in nine cases of large anterior defects or by using a 2 mm polytetrafluoroethylene (e-PTFE) mesh in nine cases of lateral or posterior defects. Support from a plastic surgeon was necessary to cover the full-thickness chest wall defects in seven cases. Adjuvant oncologic treatment was administered in 13 patients. Local recurrences were observed in five cases where surgical reintervention was finally necessary in two cases. Recurrences were associated with larger tumors, histology of malignant fibrous histiocytoma, and initial incomplete resection or misdiagnosis made by nonthoracic surgeons. Three patients died during the study period because of recurrent disease or complications of treatment for recurrent disease. Conclusion Chest wall tumors are in their majority mesenchymal neoplasms, which often require major chest wall resection for their eradication. Long-term survival is expected in low-grade tumors where a radical resection is achieved, while big tumors and histology of malignant fibrous histiocytoma are connected with the increase rate of recurrence.
Collapse
Affiliation(s)
- Christophoros N Foroulis
- Department of Cardiothoracic Surgery, Aristotle University School of Medicine, AHEPA University Hospital, Thessaloniki, Greece
| | - Athanassios D Kleontas
- Department of Cardiothoracic Surgery, Aristotle University School of Medicine, AHEPA University Hospital, Thessaloniki, Greece
| | - George Tagarakis
- Department of Cardiothoracic Surgery, Aristotle University School of Medicine, AHEPA University Hospital, Thessaloniki, Greece
| | - Chryssoula Nana
- Department of Cardiothoracic Surgery, Aristotle University School of Medicine, AHEPA University Hospital, Thessaloniki, Greece
| | - Ioannis Alexiou
- Department of Cardiothoracic Surgery, Aristotle University School of Medicine, AHEPA University Hospital, Thessaloniki, Greece
| | - Vasilis Grosomanidis
- Department of Cardiothoracic Surgery, Aristotle University School of Medicine, AHEPA University Hospital, Thessaloniki, Greece
| | - Paschalis Tossios
- Department of Cardiothoracic Surgery, Aristotle University School of Medicine, AHEPA University Hospital, Thessaloniki, Greece
| | - Elena Papadaki
- Pulmonary Department-Oncology Unit, "G. Papanikolaou" General Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Ioannis Kioumis
- Pulmonary Department-Oncology Unit, "G. Papanikolaou" General Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Sofia Baka
- Oncology Department, European Interbalkan Medical Center, Thessaloniki, Greece
| | - Paul Zarogoulidis
- Pulmonary Department-Oncology Unit, "G. Papanikolaou" General Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Kyriakos Anastasiadis
- Department of Cardiothoracic Surgery, Aristotle University School of Medicine, AHEPA University Hospital, Thessaloniki, Greece
| |
Collapse
|