Comparison of mersilene mesh-methyl metacrylate sandwich and polytetrafluoroethylene grafts for chest wall reconstruction

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

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

Complications of Chest Wall Resection in Conjunction with Pulmonary Resection

Techniques for chest wall resection and reconstruction have evolved over the years. Chest wall resection in conjunction with pulmonary resection has several complications, including pulmonary and infectious. Risk factors for complications are related to the size of the defect, number of ribs resected, and the addition of a pulmonary resection. Material used for reconstruction does not impact the overall complication rate.

Clinical Outcomes of Surgical Treatment for Primary Chest Wall Soft Tissue Sarcoma

Background

This study investigated the clinical outcomes of surgical treatment of primary chest wall soft tissue sarcoma (CW-STS).

Methods

Thirty-one patients who underwent surgery for CW-STS between 2000 and 2015 were retrospectively reviewed. The disease-free and overall survival rates were estimated using the Kaplan-Meier method, and prognostic factors were analyzed using a Cox proportional hazards model.

Results

The median follow-up duration was 65.6 months. The most common histologic type of tumor was malignant fibrous histiocytoma (29%). The resection extended to the soft tissue in 14 patients, while it reached full thickness in 17 patients. Complete resection was achieved in 27 patients (87.1%). There were 5 cases of local recurrence, 3 cases of distant metastasis, and 5 cases of combined recurrence. The 5-year disease-free rate was 49%. Univariate analysis indicated that incomplete resection (p<0.001) and stage (p=0.062) were possible risk factors for recurrence. Multivariate analysis determined that incomplete resection (p=0.013) and stage (p=0.05) were significantly associated with recurrence. The overall 5- and 10-year survival rates were 86.8% and 64.3%, respectively. No prognostic factor for survival was identified.

Conclusion

Long-term primary CW-STS surgery outcomes were found to be favorable. Incomplete microscopic resection and stage were risk factors for recurrence.

Sternum reconstruction using titanium plates matched with "sandwich" Gore-Tex meshes

Chest wall reconstruction after extensive resection may be technically difficult, and which technique permits to obtain the right compromise between rigidity and plasticity of the chest wall is still argument of debate. Indeed, many techniques and materials have been proposed and tested to cover chest wall defects and to ensure correct respiratory movements, but unique results still miss. We herein report the case of a 55-years old woman with soft-tissue sarcoma involving the sternum treated with sternum and anterior ribs arch resection (from the second to the fourth). The chest wall defect was repaired using titanium plates and Gore-Tex meshes combined as a "sandwich". The scope was to obtain a synchronous movement of the prosthesis with the titanium ribs, reducing the scratching between the different materials and avoiding paradox chest wall movements.

Chest Wall Resection and Reconstruction: Management of Complications

The main indications for chest wall resection continue to be tumors, infection, and radiation injury. Complications surrounding chest wall resection procedures include respiratory failure, wound complications, and prosthetic complications. The main risk factors for complications are size of defect, age, and concomitant lung resection. Most complications related to either the wound or the prosthesis are late postoperative events. The identification of complications related to chest wall reconstruction requires clinical examination and the use of detailed imaging studies. The management of both prosthetic and wound complications often requires reoperation and removal of the prosthesis combined with soft tissue wound management.

Chest wall implantation metastasis caused by percutaneous radiofrequency ablation for hepatic tumor

We report a very rare case of a 55-year-old man with chest wall metastatic tumor caused by seeding of hepatocellular carcinoma after percutaneous radiofrequency ablation (RFA) for hepatic tumor 42 months after the initial operation. The patient was managed with aggressive full-thickness chest wall resection and reconstruction with a Prolene (Ethicon, Somerville, NJ) and methyl methacrylate sandwich graft and subsequent musculocutaneous free-flap transposition.

Optimizing reconstruction of oncologic sternectomy defects based on surgical outcomes

BACKGROUND

The optimal strategy for oncologic sternectomy reconstruction has not been well characterized. We hypothesized that the major factors driving the reconstructive strategy for oncologic sternectomy include the need for skin replacement, extent of the bony sternectomy defect, and status of the internal mammary vessels.

STUDY DESIGN

We reviewed consecutive oncologic sternectomy reconstructions performed at The University of Texas MD Anderson Cancer Center during a 10-year period. Regression models analyzed associations between patient, defect, and treatment factors and outcomes to identify patient and treatment selection criteria. We developed a generalized management algorithm based on these data.

RESULTS

Forty-nine consecutive patients underwent oncologic sternectomy reconstruction (mean follow-up 18 ± 23 months). More sternectomies were partial (74%) rather than total/subtotal (26%). Most defects (n = 40 [82%]) required skeletal reconstruction. Pectoralis muscle flaps were most commonly used for sternectomies with intact overlying skin (64%) and infrequently used when a presternal skin defect was present (36%; p = 0.06). Free flaps were more often used for total/subtotal vs partial sternectomy defects (75% vs 25%, respectively; p = 0.02). Complication rates for total/subtotal sternectomy and partial sternectomy were equivalent (46% vs 44%, respectively; p = 0.92).

CONCLUSIONS

Despite more extensive sternal resections, total/subtotal sternectomies resulted in equivalent postoperative complications when combined with the appropriate soft-tissue reconstruction. Good surgical and oncologic outcomes can be achieved with defect-characteristic-matched reconstructive strategies for these complex oncologic sternectomy resections.

Reconstruction of chest wall using a two-layer prolene mesh and bone cement sandwich

Wide surgical resection is the most effective treatment for the vast majority of chest wall tumors. This study evaluated the clinical success of chest wall reconstruction using a Prolene mesh and bone cement prosthetic sandwich. The records of all patients undergoing chest wall resection and reconstruction were reviewed. Surgical indications, the location and size of the chest wall defect, diaphragm resection, pulmonary performance, postoperative complications, and survival of each patient were recorded. From 1998 to 2008, 43 patients (27 male, 16 female; mean age of 48 years) underwent surgery in our department to treat malignant chest wall tumors: chondrosarcoma (23), osteosarcoma (8), spindle cell sarcoma (6), Ewing's sarcoma (2), and others (4). Nine sternectomies and 34 antero-lateral and postero-lateral chest wall resections were performed. Postoperatively, nine patients experienced respiratory complications, and one patient died because of respiratory failure. The overall 4-year survival rate was 60 %. Chest wall reconstruction using a Prolene mesh and bone cement prosthetic sandwich is a safe and effective surgical procedure for major chest wall defects.

Complete resection of an isolated chest wall metastasis from esophageal carcinoma after transhiatal esophagectomy and gastric pull-up at one and a half-year follow-up

INTRODUCTION

In esophageal cancer, the liver, lung, and bones are the most common sites of visceral metastases. Isolated chest wall metastases are quite extraordinary and occur very rarely.

METHODS

In February 2004, a 59-year-old male patient was admitted with esophageal adenocarcinoma. Preoperative routine staging failed to detect any metastases. A transhiatal esophagectomy and retrosternal gastric pull-up with cervical esophago-gastrostomy were performed. The definitive histopathological staging showed an adenocarcinoma, Union Internationale Contre le Cancer stage I. The first check-up 6 months later consisted of a computed tomographic scan of the neck, thorax, and abdomen as well as endoscopy, and raised no suspicion of distant metastases and/or local recurrence. We detected an isolated subcutaneous tumor at the area of the right ventrolateral chest wall 18 months after surgery. The magnetic resonance tomography scan of the thorax showed a solid subcutaneous expansion. The surgical biopsy of this lesion confirmed the suspicion of an isolated chest wall metastasis of the resected esophageal adenocarcinoma.

RESULTS

A complete resection of the metastasis was performed without any complications, and the chest wall deficiency became stabilized using a Prolene-Mesh and could be closed directly by skin and subcutaneous tissue.

CONCLUSIONS

In case of transhiatal esophageal resection without operative participation of the chest wall, an isolated thoracic wall metastasis can be explained by an occult widespread dissemination of the tumor cells along the extensive esophageal lymphatic and hematogenous system. The final decision of surgical resection of this chest wall metastasis should always be made by an interdisciplinary tumor board.