Results of Chest Wall Resection and Reconstruction With and Without Rigid Prosthesis

ArticleinThe Annals of thoracic surgery 81(1):279-85 · February 2006with39 Reads
DOI: 10.1016/j.athoracsur.2005.07.001 · Source: PubMed
Chest wall resections are associated with significant morbidity, with respiratory failure in as many as 27% of patients. We hypothesized that our selective use of a rigid prosthesis for reconstruction reduces respiratory complications. The records of all patients undergoing chest wall resection and reconstruction were reviewed. Patient demographics, use of preoperative therapy, the location and size of the chest wall defect, performance of lung resection if any, the type of prosthesis, and postoperative complications were recorded. Predictor of complications were identified by chi2 and logistic regression analyses. From January 1, 1995, to July 1, 2003, 262 patients (median age, 60 years) underwent chest wall resection for tumor in 251 (96%), radiation necrosis in 7 (2.7%); and infection in 4 patients (1.3%). The median defect size was 80 cm2 (range, 2.7 to 1,200 cm2) and the median number of ribs resected was 3 (range, 1 to 8). Major lung resection was performed in 85 patients (34%). Prosthetic reconstruction was rigid (polypropylene mesh/methylmethacrylate composite) in 112 (42.7%), nonrigid (polytetrafluoroethylene or polypropylene mesh) in 97 (37%), and none in 53 patients. Postoperatively, 10 patients died (3.8%), 4 of whom had pneumonectomy plus chest wall resection. Respiratory failure occurred in 8 patients (3.1%). By multivariate analysis, the size of the chest wall defect was the most significant predictor of complications. Our incidence of respiratory failure is lower than previously reported and may relate to our use of rigid repair for defects likely to cause a flail segment. Pneumonectomy plus chest wall resection should be performed only in highly selected patients.
    • "The main weaknesses in this study are the limited number of patients and relatively short follow-up period. Complications are common following chest wall reconstruction and are reported to range from 33-46 %, with respiratory complications being the most frequent at 11-24 % [10, 13, 17]. While a majority of these occur in the early post-operative period, chest wall reconstructions are known to be susceptible to later failure secondary to the mobility of the thorax with constant respiratory motion. "
    [Show abstract] [Hide abstract] ABSTRACT: Purpose: We present a surgical technique for chest wall reconstruction using custom-designed titanium implants developed for two female patients to provide both chest wall symmetry and adequate stability for staged breast reconstruction. Methods: A retrospective review was performed for two adolescent female patients with large chest wall defects who underwent the described technique. The etiology of the chest wall deficiency was secondary to Poland's syndrome in one patient, and secondary to surgical resection of osteosarcoma in the other patient. For each patient, a fine-cut computed tomography scan was obtained to assist with implant design. After fabrication of the prosthesis, reconstruction was performed though a curvilinear thoracotomy approach with attachment of the implant to the adjacent ribs and sternum. Wound closure was obtained with use of synthetic graft material, local soft tissue procedures, and flap procedures as necessary. Results: The two patients were followed post-operatively for 35 and 38 months, respectively. No intra-operative or post-operative complications were identified. Mild scoliosis that had developed in the patient following chest wall resection for osteosarcoma did not demonstrate any further progression following reconstruction. Conclusions: We conclude that this technique was successful at providing a stable chest wall reconstruction with satisfactory cosmetic results in our patients.
    Full-text · Article · Jan 2016
    • "Costal defects can be stabilized with a mesh. However, the partial or total excision of the sternum requires a rigid prosthetic mate- rial [6] (titanium, steel, cemented mesh) to prevent respiratory failure and minimize the risk of respiratory complications [2, 7] . In our series we used mostly titanium bars/mesh in sternal defects with good results regarding wall stability, showing resistance to infection and compatibility with adjacent tissue. "
    Article · Apr 2015
    • "The decision of whether to perform reconstruction is based on lesion location and defect size. Chest wall reconstruction is recommended when at least 3 ribs are resected or the size of the chest wall defect is >3 cm [5]. A case of an asymptomatic 29-years old female with a tumor size of 10 cm × 12 cm on the left anterior chest wall involving the 8th rib is presented through this paper which was later diagnosed histologically as chondrosarcoma with atypical chondroblastoma like areas. "
    [Show abstract] [Hide abstract] ABSTRACT: Chondrosarcoma of a rib is a very rare malignant tumor of the bone. Most patients were present with an enlarging painful anterior chest wall tumor. We present a case of an asymptomatic 29-years old female with a tumor size of 10cm×12cm on the left anterior chest wall involving the 8th rib. CT scan with intravenous contrast is the gold standard for radiological imaging and planning for surgery. Since chondrosarcoma is less sensitive to chemotherapy and radiotherapy, surgical treatment with extensive resection with a sufficient margin is considered first line treatment. Copyright © 2015 Z. Published by Elsevier Ltd.. All rights reserved.
    Full-text · Article · Mar 2015
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