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Kolobaev IV, Baranovskii D, Usachev V, Afonin G, Aleksandrov O, Usacheva A, Klabukov ID, Shegay P, Ivanov S, Kaprin A. The World's First Implantation of a Personalized Microporous Titanium Sternum with Motile Costal Clip Connections: A Case Report. IRANIAN JOURNAL OF MEDICAL SCIENCES 2024; 49:268-271. [PMID: 38680226 PMCID: PMC11053257 DOI: 10.30476/ijms.2023.97060.2873] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/25/2022] [Revised: 02/14/2023] [Accepted: 03/04/2023] [Indexed: 05/01/2024]
Abstract
Extensive chest wall defects occur in 28% of all sternal resection cases and are a major challenge in thoracic surgery. These cases are generally considered "critical defects" requiring primary or secondary reconstruction using various types of flaps, mesh repairs, bone autografts, or endoprosthesis. The past decade witnessed rapid advances in the application of personalized endoprostheses in thoracic surgery. Surgeons began to use carbon or titanium grafts for personalized sternum replacement. The main advantages of these implants are superior cosmetic effect, biocompatibility, and low risk of infection. Herein, we present a case of a 55-year-old patient with an indication for extended sternum resection due to metastatic thyroid cancer. The patient underwent extended sternum resection, followed by the implantation of a personalized microporous titanium sternum equipped with graspers for atraumatic rib fixation.
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Affiliation(s)
- Ilya V. Kolobaev
- A. Tsyb Medical Radiological Research Center, Branch of the National Medical Research Radiological Center, Obninsk, Russia
| | - Denis Baranovskii
- A. Tsyb Medical Radiological Research Center, Branch of the National Medical Research Radiological Center, Obninsk, Russia
- Peoples’ Friendship University of Russia (RUDN University), Moscow, Russia
| | - Vladimir Usachev
- A. Tsyb Medical Radiological Research Center, Branch of the National Medical Research Radiological Center, Obninsk, Russia
| | - Grigoriy Afonin
- A. Tsyb Medical Radiological Research Center, Branch of the National Medical Research Radiological Center, Obninsk, Russia
| | - Oleg Aleksandrov
- P.A. Hertzen Moscow Oncology Research Institute, Branch of the National Medical Research Radiological Center of the Ministry of Health of Russia, Moscow, Russia
| | - Anna Usacheva
- A. Tsyb Medical Radiological Research Center, Branch of the National Medical Research Radiological Center, Obninsk, Russia
| | - Ilya D. Klabukov
- Peoples’ Friendship University of Russia (RUDN University), Moscow, Russia
- National Medical Research Radiological Center, Obninsk, Russia
| | - Peter Shegay
- National Medical Research Radiological Center, Obninsk, Russia
| | - Sergei Ivanov
- A. Tsyb Medical Radiological Research Center, Branch of the National Medical Research Radiological Center, Obninsk, Russia
| | - Andrey Kaprin
- Peoples’ Friendship University of Russia (RUDN University), Moscow, Russia
- National Medical Research Radiological Center, Obninsk, Russia
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Asanuma K, Tsujii M, Hagi T, Nakamura T, Uchiyama T, Adachi R, Nakata K, Kataoka T, Sudo A. Pedicled flap transfer after chest wall malignant tumor resection and potential risk of postoperative respiratory problems for patients with low FEV1.0. Front Surg 2024; 11:1357265. [PMID: 38505411 PMCID: PMC10948408 DOI: 10.3389/fsurg.2024.1357265] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2023] [Accepted: 02/01/2024] [Indexed: 03/21/2024] Open
Abstract
Introduction Musculoskeletal transfer for chest wall tissue defects is a crucial method, and pedicled flaps around the chest wall are preferred in terms of location and simplicity of transfer. These require special care because of complications such as partial necrosis, fistula, wound dehiscence, infection, hematoma and restricted function of the arm or shoulder. However, studies of respiratory function are rare. In the present study, we investigated the complications including respiratory problems after wide resection for malignant chest wall tumors with musculoskeletal pedicle transfer. Methods A total of 13 patients (15 operations) who underwent wide resection of primary, recurrent, or metastatic malignant chest wall tumors and musculoskeletal pedicle transfer for coverage of tissue defects were enrolled in the present study. A retrospective review of all patients was performed using data collected from hospital records and follow-up information. The complications of musculoskeletal transfer after chest wall wide resection, including respiratory problems, are evaluated. Results Rib or sternal resection was performed in 12 operations, and only soft tissue resection was performed in 3 operations. Latissimus dorsi (LD) pedicle transfer was performed in 13 operations, and pectoralis major (PM) pedicle transfer was performed in 2 operations; basically, wounds were closed primarily. Surgical complications were observed following 5 of the 15 operations (33.3%). Respiratory complications were seen in 7 of the 15 operations (46.7%). Patients with respiratory complications showed significantly lower preoperative FEV1.0% values than those without respiratory complications (p = 0.0196). Skin resection area tended to be higher in the complication group than in the no complication group (p = 0.104). Discussion Pedicled myocutaneous flap transfers such as LD, PM, and rectus abdominus can be used following multiple resections. After harvesting LD or PM, the wound can be closed primarily for an 8-10-cm skin defect in patients with normal respiratory function. However, for patients with low FEV1.0%, after primary closure of LD or PM transfer for wide soft tissue defects, attention should be paid to postoperative respiratory complications.
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Affiliation(s)
- Kunihiro Asanuma
- Department of Orthopedic Surgery, Mie University School of Medicine, Tsu City, Japan
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Aranda JL, Gomez MT, Fuentes M, Rivas C, Forcada C, Jimenez MF. Sternal resection and reconstruction: a review. J Thorac Dis 2024; 16:708-721. [PMID: 38410553 PMCID: PMC10894421 DOI: 10.21037/jtd-23-450] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2023] [Accepted: 12/08/2023] [Indexed: 02/28/2024]
Abstract
Sternal resection and reconstruction is a rare but sometimes challenging procedure due to its profound anatomical and functional implications. For these reasons, an adequate preoperative evaluation is crucial in each patient, especially when we are faced with malignant lesions that sometimes require extensive radical resections, thus demanding an integrated reconstructive strategy that allows stabilizing the chest wall, protecting the underlying mediastinum and minimize resulting deformity. The large number of available reconstruction techniques and the lack of quality studies for their analysis mean that sternal reconstruction depends to a great extent on the consensus of experts or, more frequently, on the simple preference of each surgical team. This article aims to provide an overview of sternal resection and reconstruction. Indications for partial versus total or subtotal sternectomy are suggested and their surgical and oncological outcomes are presented. The use of rigid or semi-rigid prostheses is an ongoing debate, although recent functional data advise reserving rigid reconstructions for extensive defects. Sternectomy for primary tumors or local tumor involvement has a good prognosis with an overall survival of 5 and 10 years: 67% and 58%, respectively, provided that a radical resection with free surgical margins is performed. Breast cancer is the most common secondary sternal tumor, and surgery can offer 5-year overall survival ranging from 20% to 50% provided an R0 resection is achieved, although radical surgery does not appear to decrease rates. of recurrence. Metastases of origin other than the breast give the worst results (less than 40% at 36 months and 0% at 5 years) and although the data available on these cases are limited, the radicality of the resection does not seem to modify the survival or recurrence rates, so a conservative approach is probably more appropriate.
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Affiliation(s)
- Jose L Aranda
- Thoracic Surgery Unit, Salamanca University Hospital, Salamanca, Spain
| | - María T Gomez
- Thoracic Surgery Unit, Salamanca University Hospital, Salamanca, Spain
| | - Marta Fuentes
- Thoracic Surgery Unit, Salamanca University Hospital, Salamanca, Spain
| | - Cristina Rivas
- Thoracic Surgery Unit, Salamanca University Hospital, Salamanca, Spain
| | - Clara Forcada
- Thoracic Surgery Unit, Salamanca University Hospital, Salamanca, Spain
| | - Marcelo F Jimenez
- Thoracic Surgery Unit, Salamanca University Hospital, Salamanca, Spain
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Merhej H, Ali M, Nakagiri T, Zinne N, Selman A, Golpon H, Goecke T, Zardo P. Long-Term Outcome of Chest Wall and Diaphragm Repair with Biological Materials. Thorac Cardiovasc Surg 2023. [PMID: 37914155 DOI: 10.1055/a-2202-4154] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2023]
Abstract
INTRODUCTION Chest wall and/or diaphragm reconstruction aims to preserve, restore, or improve respiratory function; conserve anatomical cavities; and upkeep postural and upper extremity support. This can be achieved by utilizing a wide range of different grafts made of synthetic, biological, autologous, or bioartificial materials. We aim to review our experience with decellularized bovine pericardium as graft in the past decade. PATIENTS AND METHODS We conducted a retrospective analysis of patients who underwent surgical chest wall and/or diaphragm repair with decellularized bovine pericardium between January 1, 2012 and January 13, 2022 at our institution. All records were screened for patient characteristics, intra-/postoperative complications, chest tube and analgesic therapy duration, length of hospital stay, presence or absence of redo procedures, as well as morbidity and 30-day mortality. We then looked for correlations between implanted graft size and postoperative complications and gathered further follow-up information at least 2 months after surgery. RESULTS A total of 71 patients either underwent isolated chest wall (n = 51), diaphragm (n = 12), or pericardial (n = 4) resection and reconstruction or a combination thereof. No mortality was recorded within the first 30 days. Major morbidity occurred in 12 patients, comprising secondary respiratory failure requiring bronchoscopy and invasive ventilation in 8 patients and secondary infections and delayed wound healing requiring patch removal in 4 patients. There was no correlation between the extensiveness of the procedure and extubation timing (chi-squared test, p = 0.44) or onset of respiratory failure (p = 0.27). CONCLUSION A previously demonstrated general viability of biological materials for various reconstructive procedures appears to be supported by our long-term results.
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Affiliation(s)
- Hayan Merhej
- Department of Cardiothoracic Transplantation and Vascular Surgery, Hannover Medical School, Hannover, Niedersachsen, Germany
| | - Mohammed Ali
- Department of Cardiothoracic Transplantation and Vascular Surgery, Hannover Medical School, Hannover, Niedersachsen, Germany
| | - Tomoyuki Nakagiri
- Department of Cardiothoracic Transplantation and Vascular Surgery, Hannover Medical School, Hannover, Niedersachsen, Germany
| | - Norman Zinne
- Department of Cardiothoracic, Transplantation and Vascular Surgery, Medizinische Hochschule Hannover Zentrum Chirurgie, Hannover, Germany
| | - Alaa Selman
- Department of Cardiothoracic Transplantation and Vascular Surgery, Hannover Medical School, Hannover, Niedersachsen, Germany
| | - Heiko Golpon
- Department of Pneumology and Respiratory Medicine, Hannover Medical School, Hannover, Germany
| | - Tobias Goecke
- Department of Cardiothoracic Transplantation and Vascular Surgery, Hannover Medical School, Hannover, Niedersachsen, Germany
| | - Patrick Zardo
- Department of Cardiothoracic Transplantation and Vascular Surgery, Hannover Medical School, Hannover, Niedersachsen, Germany
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Arunwatthanangkul P, Piyabenjarad P, Wisitthipakdeekul S, Chobpenthai T. Innovative method with two-stage surgery for Ewing sarcoma with personalized distal clavicle reconstruction: A case report and diagnosis review. Front Oncol 2023; 13:1134324. [PMID: 37064107 PMCID: PMC10090420 DOI: 10.3389/fonc.2023.1134324] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2022] [Accepted: 03/14/2023] [Indexed: 03/31/2023] Open
Abstract
A 13-year-old boy presented with a growing lump on his left clavicle for 5 months. The plain radiograph revealed an osteolytic mass with aggressive periosteal reaction, suggesting a malignant lesion. The results of advanced imaging and histopathological examinations revealed that the patient had Ewing sarcoma without metastasis. The two-stage surgery was as follows: resection–observation–reconstruction. The underlying rationale was that Ewing sarcoma has a high recurrence. After 2 years of resection, the patient had remission, and he currently has a personal 3D-printed titanium implant with intact shoulder function.
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Zhang H, Hou B, Xia T, Ji L, Li J, Chen T, Shang G. Primary sternal tumour resection and reconstruction with LARS mesh-bone cement sandwich by 3D-printing: Case reports. Front Bioeng Biotechnol 2023; 11:1024480. [PMID: 37091347 PMCID: PMC10119393 DOI: 10.3389/fbioe.2023.1024480] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2022] [Accepted: 03/31/2023] [Indexed: 04/25/2023] Open
Abstract
Background: There are many reconstruction methods after sternal tumor resection, but the method that LARS mesh combines with bone-cement has not been reported. Case report: A 54-year-old female patient and a 55-year-old male patient admitted to our department all presented with sternum masses, but neither presented with respiratory disorders. In women with limited manubrium sternum lesions, we resected the manubrium sternum completely. In men with sternal lesions, we removed part of the sternum and part of the sternocostal joint. The patients recovered well after surgery, and there were no respiratory complications and no tumor recurrence during the 1-year follow-up respectively. Conclusion: We report two cases of sternal defect repair using LARS mesh combined with bone cement. This method is safe and stable, and can achieve satisfactory results.
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Affiliation(s)
- He Zhang
- Department of Bone and Soft Tissue Oncology, Department of Surgery, Shengjing Hospital, China Medical University, ShenYang, Liaoning, China
| | - Bo Hou
- Department of Bone and Soft Tissue Oncology, Department of Surgery, Shengjing Hospital, China Medical University, ShenYang, Liaoning, China
| | - Tienan Xia
- Department of Orthopedics, Fifth People’s Hospital of Shenyang, ShenYang, Liaoning, China
| | - Lu Ji
- Department of Gynecology and Obstetrics, Shengjing Hospital, China Medical University, ShenYang, Liaoning, China
| | - Jiatong Li
- Department of Bone and Soft Tissue Oncology, Department of Surgery, Shengjing Hospital, China Medical University, ShenYang, Liaoning, China
| | - Ting Chen
- Department of Bone and Soft Tissue Oncology, Department of Surgery, Shengjing Hospital, China Medical University, ShenYang, Liaoning, China
- *Correspondence: Ting Chen, ; Guanning Shang,
| | - Guanning Shang
- Department of Bone and Soft Tissue Oncology, Department of Surgery, Shengjing Hospital, China Medical University, ShenYang, Liaoning, China
- *Correspondence: Ting Chen, ; Guanning Shang,
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Colella S, Brandimarte A, Marra R, Marinari S, D’Incecco A, Di Genesio Pagliuca M, De Vico A, Crisci R, Divisi D. Chest wall reconstruction in benign and malignant tumors with non-rigid materials: An overview. Front Surg 2022; 9:976463. [PMID: 35990091 PMCID: PMC9381953 DOI: 10.3389/fsurg.2022.976463] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2022] [Accepted: 07/11/2022] [Indexed: 11/13/2022] Open
Abstract
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.
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Affiliation(s)
- Sara Colella
- Unit of Respiratory Diseases, “G. Mazzini” Hospital, Teramo, Italy
| | | | - Roberta Marra
- Unit of Respiratory Diseases, “V. Fazzi” Hospital, Lecce, Italy
| | - Stefano Marinari
- Unit of Respiratory Diseases, “G. Mazzini” Hospital, Teramo, Italy
| | - Armida D’Incecco
- Medical Oncology Unit, “Giuseppe Mazzini” Hospital, Teramo, Italy
| | | | - Andrea De Vico
- Department of Life, Health and Environmental Sciences, University of L’Aquila, Thoracic Surgery Unit, “Giuseppe Mazzini” Hospital, Teramo, Italy
| | - Roberto Crisci
- Department of Life, Health and Environmental Sciences, University of L’Aquila, Thoracic Surgery Unit, “Giuseppe Mazzini” Hospital, Teramo, Italy
| | - Duilio Divisi
- Department of Life, Health and Environmental Sciences, University of L’Aquila, Thoracic Surgery Unit, “Giuseppe Mazzini” Hospital, Teramo, Italy
- Correspondence: Duilio Divisi ;
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Bertolaccini L, Spaggiari L, Cusato J. Editorial: Bench Research Behind Lung Cancer Surgery. Front Surg 2022; 9:936922. [PMID: 35800115 PMCID: PMC9253461 DOI: 10.3389/fsurg.2022.936922] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2022] [Accepted: 06/03/2022] [Indexed: 11/28/2022] Open
Affiliation(s)
- Luca Bertolaccini
- Department of Thoracic Surgery, IEO, European Institute of Oncology IRCCS, Milan, Italy
- Correspondence: Luca Bertolaccini
| | - Lorenzo Spaggiari
- Department of Thoracic Surgery, IEO, European Institute of Oncology IRCCS, Milan, Italy
- Department of Oncology and Hemato-Oncology, University of Milan, Milan, Italy
| | - Jessica Cusato
- Department of Medical Sciences, University of Turin, Turin, Italy
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