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Palmesano M, Lisa A, Storti G, Bottoni M, Gottardi A, Colombo G, Barbieri B, Garusi C, Sala P, Lo Iacono G, Spaggiari L, De Lorenzi F, Cervelli V, Rietjens M. Resection to restoration: Assessing the synergy of polypropylene mesh (Marlex®) combined with methyl-methacrylate and latissimus dorsi flap for primary chest wall sarcomas. J Plast Reconstr Aesthet Surg 2024; 93:157-162. [PMID: 38691953 DOI: 10.1016/j.bjps.2024.04.022] [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: 11/15/2023] [Revised: 02/13/2024] [Accepted: 04/05/2024] [Indexed: 05/03/2024]
Abstract
BACKGROUND Chest-wall sarcomas are treated with extensive resections and complex defect reconstruction to restore chest-wall integrity. It is a difficult surgical procedure that incorporates a multidisciplinary approach for the best outcome, preventing paradoxical chest movement issues and reducing complications. OBJECTIVE We aimed to describe our experience of chest-wall reconstruction using polypropylene mesh (Marlex® Mesh) combined with methyl-methacrylate and soft-tissue coverage with a latissimus dorsi flap following sarcoma resection. PATIENTS AND METHODS Among the 53 patients treated for primary chest-wall sarcomas at the European Institute of Oncology (IEO) in Milan, Italy, from 1998 to 2020, 14 cases underwent chest-wall resection and reconstruction using polypropylene mesh, methyl-methacrylate and the latissimus dorsi flap. Patients with locally advanced breast cancers, locally advanced lung cancers, squamous cell carcinomas, and other secondary chest-wall malignancies were excluded from the study, as were the patients with different types of chest-wall reconstruction. RESULTS In this study, 14 patients (6 men and 8 women) with various primary chest-wall sarcomas were enrolled. On an average, 2 ribs (range: 1-5) were removed during the surgeries, and the chest-wall defects ranged from 20 to 150 cm2 with an average size of 73 cm2. The mean follow-up period for these patients was approximately 63.80 months CONCLUSION: The combination of Marlex® mesh filled with methyl-methacrylate and covered using latissimus dorsi myocutaneous flap provides safe, low-cost and effective single-stage chest-wall reconstruction after surgery for primary sarcomas.
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Affiliation(s)
- Marco Palmesano
- Department of Plastic Surgery, University of Rome "Tor Vergata," Viale Oxford 81, Rome, Italy
| | - Andrea Lisa
- Department of Plastic and Reconstructive Surgery, European Institute of Oncology, IRCCS, 20141 Milan, Italy; Humanitas University Department of Biomedical Sciences, Humanitas University, Via Rita Levi Montalcini 4, Pieve Emanuele, Milan 20090, Italy; PhD Program in Applied Medical-Surgical Sciences, Department of Surgical Sciences, University of Rome "Tor Vergata," Viale Oxford 81, 00133 Rome, Italy
| | - Gabriele Storti
- Department of Plastic Surgery, University of Rome "Tor Vergata," Viale Oxford 81, Rome, Italy
| | - Manuela Bottoni
- Department of Plastic and Reconstructive Surgery, European Institute of Oncology, IRCCS, 20141 Milan, Italy
| | - Alessandra Gottardi
- Department of Plastic and Reconstructive Surgery, European Institute of Oncology, IRCCS, 20141 Milan, Italy
| | - Giulia Colombo
- Department of Plastic and Reconstructive Surgery, European Institute of Oncology, IRCCS, 20141 Milan, Italy
| | - Benedetta Barbieri
- Department of Plastic and Reconstructive Surgery, European Institute of Oncology, IRCCS, 20141 Milan, Italy
| | - Cristina Garusi
- Department of Plastic Surgery, University of Rome "Tor Vergata," Viale Oxford 81, Rome, Italy
| | - Pietro Sala
- Department of Plastic and Reconstructive Surgery, European Institute of Oncology, IRCCS, 20141 Milan, Italy
| | - Giorgio Lo Iacono
- Department of Thoracic Surgery, IEO, European Institute of Oncology IRCCS, 20141 Milan, Italy
| | - Lorenzo Spaggiari
- Department of Thoracic Surgery, IEO, European Institute of Oncology IRCCS, 20141 Milan, Italy; Department of Oncology and Hemato-Oncology, University of Milan, 20122 Milan, Italy.
| | - Francesca De Lorenzi
- Department of Plastic and Reconstructive Surgery, European Institute of Oncology, IRCCS, 20141 Milan, Italy
| | - Valerio Cervelli
- Department of Plastic Surgery, University of Rome "Tor Vergata," Viale Oxford 81, Rome, Italy
| | - Mario Rietjens
- Department of Plastic and Reconstructive Surgery, European Institute of Oncology, IRCCS, 20141 Milan, Italy
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Qin C, Xia Q, Chen Z, Zhou Q, Zheng X. En bloc resection of the recurrent pleural mesothelioma and reconstruction of the chest wall after immunotherapy: A case report. Thorac Cancer 2023; 14:3063-3066. [PMID: 37658846 PMCID: PMC10599967 DOI: 10.1111/1759-7714.15095] [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: 07/17/2023] [Revised: 08/19/2023] [Accepted: 08/21/2023] [Indexed: 09/05/2023] Open
Abstract
Malignant pleural mesothelioma (MPM) is associated with previous asbestos exposure, while more clinical insights into this disease have come from other case studies. Maximal cytoreduction is critical in disease control and might help to improve the prognosis. Here, a 41-year-old female presented with a 6-month history of a mass detected in the chest wall following resection of a right pleural mesothelioma 2 years previously. A fluorodeoxyglucose positron emission tomography/computed tomography scan showed a right chest wall mass with a blurred boundary 8.9 cm × 3.7 cm in size. The patient had received one cycle of bevacizumab, carboplatin, and pemetrexed, and two cycles of nivolumab, ipilimumab, and gemcitabine 5 months before admission. We subsequently resected the tumor, the involved diaphragm, and the fifth and sixth ribs, and titanium mesh and continuous suture were used to close the thoracic cage. The fixed paraffin-embedded tissues showed epithelioid pleural mesothelioma. The patient received nivolumab and ipilimumab postoperatively, and no recurrence was detected 16 months after surgery. En bloc resection with reconstructive surgery effectively removed the locally advanced malignancy and restored the biological function of the thorax with a favorable prognosis. Neoadjuvant immunotherapy might therefore be conducive to radical resection and perioperative immunotherapy might improve the prognosis.
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Affiliation(s)
- Changlong Qin
- Lung Cancer Center, West China HospitalSichuan UniversityChengduPeople's Republic of China
- Lung Cancer Institute, West China Hospital, Sichuan UniversityChengduPeople's Republic of China
| | - Qinghong Xia
- Operating Room of Anesthesia Surgery Center, West China HospitalSichuan UniversityChengduPeople's Republic of China
- West China School of NursingSichuan UniversityChengduPeople's Republic of China
| | - Zi‐Jia Chen
- Lung Cancer Center, West China HospitalSichuan UniversityChengduPeople's Republic of China
- Lung Cancer Institute, West China Hospital, Sichuan UniversityChengduPeople's Republic of China
| | - Qinghua Zhou
- Lung Cancer Center, West China HospitalSichuan UniversityChengduPeople's Republic of China
- Lung Cancer Institute, West China Hospital, Sichuan UniversityChengduPeople's Republic of China
| | - Xi Zheng
- Lung Cancer Center, West China HospitalSichuan UniversityChengduPeople's Republic of China
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Duranti L, Tavecchio L. New perspectives in prosthetic reconstruction in chest wall resection. Updates Surg 2023:10.1007/s13304-023-01562-z. [PMID: 37402065 DOI: 10.1007/s13304-023-01562-z] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2023] [Accepted: 06/03/2023] [Indexed: 07/05/2023]
Abstract
The extension of chest wall resection for the treatment of primary and secondary tumours is still widely debated. The reconstructive strategy after extensive surgery is challenging as well as chest wall demolition itself. Reconstructive surgery aims to avoid respiratory failure and to guarantee intra-thoracic organs protection. The purpose of this review is to analyse the literature on this issue focusing on the planning strategy for chest wall reconstruction. This is a narrative review, reporting data from the most interesting studies on chest wall demolition and reconstruction. Representative surgical series on chest wall thoracic surgery were selected and described. We focused to identify the best reconstructive strategies analyzing employed materials, techniques of reconstruction, morbidity and mortality. Nowadays the new "bio-mimetic" materials in "rigid" and "non-rigid" chest wall systems reconstructive represent new horizons for the treatment of challenging thoracic diseases. Further prospective studies are warranted to identify new materials enhancing thoracic function after major thoracic excisions.
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Affiliation(s)
- Leonardo Duranti
- Thoracic Surgey Unit, Fondazione IRCCS Istituto Nazionale dei Tumori di Milano, Via G Venezian 1, 20133, Milano, Italy.
| | - Luca Tavecchio
- Thoracic Surgey Unit, Fondazione IRCCS Istituto Nazionale dei Tumori di Milano, Via G Venezian 1, 20133, Milano, Italy
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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.
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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
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Nedumaran B, Krishnasamy A, Mahalingam S, Ramasamy M, Kaliaperumal N. Primary intrathoracic synovial cell sarcoma requiring radical resection of the chest wall and diaphragm with reconstruction using titanium mesh. Indian J Thorac Cardiovasc Surg 2022; 38:644-647. [PMID: 36258822 PMCID: PMC9569248 DOI: 10.1007/s12055-022-01378-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2022] [Revised: 05/18/2022] [Accepted: 05/19/2022] [Indexed: 10/18/2022] Open
Abstract
Intrathoracic synovial cell sarcomas are extremely rare tumors with a high rate of recurrence after resection. We report one such case of synovial cell sarcoma arising from the chest wall, which was completely intrathoracic without an external component. The tumor was resected twice and in spite of adjuvant chemo-radiation the tumor recurred. Radical resection of the tumor with reconstruction of the chest wall and diaphragm using titanium mesh and polypropylene mesh respectively was done. A latissimus dorsi flap cover was provided. Titanium mesh is an excellent prosthesis of choice for reconstruction, as it provides stability and better cosmesis of the chest wall. Radical resection can be offered for suitable candidates, with very low morbidity and mortality. Supplementary Information The online version contains supplementary material available at 10.1007/s12055-022-01378-3.
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Affiliation(s)
- Bharathguru Nedumaran
- Department of Cardiothoracic Surgery, Billroth Hospitals, Shenoy nagar, Chennai, India
| | - Arunkumar Krishnasamy
- Department of Cardiothoracic Surgery, Billroth Hospitals, Shenoy nagar, Chennai, India
| | | | - Mahadevan Ramasamy
- Department of Cardiothoracic Surgery, Billroth Hospitals, Shenoy nagar, Chennai, India
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Aramini B, Masciale V, Radaelli LFZ, Sgarzani R, Dominici M, Stella F. The sternum reconstruction: Present and future perspectives. Front Oncol 2022; 12:975603. [PMID: 36387077 PMCID: PMC9649912 DOI: 10.3389/fonc.2022.975603] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2022] [Accepted: 10/12/2022] [Indexed: 11/22/2022] Open
Abstract
Sternectomy is a procedure mainly used for removing tumor masses infiltrating the sternum or treating infections. Moreover, the removal of the sternum involves the additional challenge of performing a functional reconstruction. Fortunately, various approaches have been proposed for improving the operation and outcome of reconstruction, including allograft transplantation, using novel materials, and developing innovative surgical approaches, which promise to enhance the quality of life for the patient. This review will highlight the surgical approaches to sternum reconstruction and the new perspectives in the current literature.
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Affiliation(s)
- Beatrice Aramini
- Division of Thoracic Surgery, Department of Experimental, Diagnostic and Specialty Medicine—DIMES of the Alma Mater Studiorum, University of Bologna, G.B. Morgagni—L. Pierantoni Hospital, Forlì, Italy
- *Correspondence: Beatrice Aramini,
| | - Valentina Masciale
- Cell Therapy Laboratory, Department of Medical and Surgical Sciences, University of Modena and Reggio Emilia, Modena, Italy
| | - Lorenzo Federico Zini Radaelli
- Division of Thoracic Surgery, Department of Experimental, Diagnostic and Specialty Medicine—DIMES of the Alma Mater Studiorum, University of Bologna, G.B. Morgagni—L. Pierantoni Hospital, Forlì, Italy
| | - Rossella Sgarzani
- Center of Major Burns, Plastic Surgery Unit, Maurizio Bufalini Hospital, Cesena, Italy
| | - Massimo Dominici
- Cell Therapy Laboratory, Department of Medical and Surgical Sciences, University of Modena and Reggio Emilia, Modena, Italy
- Division of Oncology, Department of Medical and Surgical Sciences, University of Modena and Reggio Emilia, Modena, Italy
| | - Franco Stella
- Division of Thoracic Surgery, Department of Experimental, Diagnostic and Specialty Medicine—DIMES of the Alma Mater Studiorum, University of Bologna, G.B. Morgagni—L. Pierantoni Hospital, Forlì, Italy
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7
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Egan KG, Emanuelli E, Butterworth JA. Chest Wall Reconstruction: A Comprehensive Analysis. Curr Surg Rep 2022; 10:109-18. [DOI: 10.1007/s40137-022-00318-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Haslam M, Dentcheva E, Shafqat MS, Petrov R. Structural Failure of the BioBridge Rib Prosthesis After Chest Wall Resection. Ann Thorac Surg 2022; 114:e233-e235. [PMID: 35051400 DOI: 10.1016/j.athoracsur.2021.12.053] [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] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/27/2021] [Revised: 12/02/2021] [Accepted: 12/18/2021] [Indexed: 11/17/2022]
Abstract
Chest wall reconstruction presents a challenging surgical problem with no universally recognized gold standard for the procedure. Various prosthetic and bioprosthetic materials exist for use in chest wall reconstruction, with bioprosthetic materials offering significant advantages in the case of a preoperatively infected surgical field. Here we present a case of the absorbable BioBridge system (Acute Innovations, Hillsboro, OR) used for chest well reconstruction and describe a novel complication of structural failure of the BioBridge plate, involving fracturing of the prosthesis with wound erosion, ultimately requiring reoperation and removal of the device.
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Affiliation(s)
- Miranda Haslam
- Department of General Surgery, Temple University Hospital, Philadelphia, Pennsylvania
| | - Eva Dentcheva
- Division of Plastic and Reconstructive Surgery, Department of Surgery, Temple University Hospital, Philadelphia, Pennsylvania
| | - M Shuja Shafqat
- Division of Plastic and Reconstructive Surgery, Department of Surgery, Temple University Hospital, Philadelphia, Pennsylvania; Division of Plastic and Reconstructive Surgery, Department of Surgical Oncology, Fox Chase Cancer Center, Philadelphia, Pennsylvania
| | - Roman Petrov
- Department of Thoracic Medicine and Surgery, Temple University Hospital, Philadelphia, Pennsylvania; Department of Surgical Oncology, Fox Chase Cancer Center, Philadelphia, Pennsylvania.
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Topolnitskiy E, Chekalkin T, Marchenko E, Yasenchuk Y. Repair of huge thoracic defect combined with hernia after multimodality treatment of breast cancer. Respir Med Case Rep 2021; 34:101558. [PMID: 34877252 DOI: 10.1016/j.rmcr.2021.101558] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2021] [Revised: 11/16/2021] [Accepted: 11/18/2021] [Indexed: 11/24/2022] Open
Abstract
A case of the successful reconstruction of an extensive chest wall defect combined with a ventral hernia in a patient after multimodality treatment of breast cancer complicated by sternal and costal osteomyelitis is presented. To recover the chest mechanics, with emphasis on the supporting function, and to repair the hernial defect, customized reinforced “sandwich” TiNi rib endografts and knitted TiNi surgical mesh were used. A five-year follow-up indicated no recurrence of osteomyelitis or ventral hernia, and no failure/migration of the implants or instability of the thorax. Excellent clinical and functional outcomes were achieved pursuant to the Enneking score.
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Joalsen I, Christian D, Rosalie A, Angga M. Reconstruction with titanium mesh following wide excision in chest wall myxofibrosarcoma: A case report. Int J Surg Case Rep 2020; 77:111-115. [PMID: 33160168 PMCID: PMC7649591 DOI: 10.1016/j.ijscr.2020.10.117] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2020] [Revised: 10/24/2020] [Accepted: 10/24/2020] [Indexed: 11/19/2022] Open
Abstract
Extensive resection in chest wall malignancy is mandatory, oftentimes leaving large defects that affect normal respiration. Various materials for chest wall reconstruction are at hand but a definite guideline is not yet available. Titanium meshes provide the suitable strength, rigidity, and flexibility for a chest wall reconstruction material. Titanium mesh is a promising alternative for a chest wall reconstruction material.
Introduction Some chest wall tumors require extensive excision that alters its stability and integrity. Various materials are available as a prosthetic albeit currently lacking in clear guidelines regarding the material of choice. Titanium-based mesh offers appropriate properties for chest wall reconstruction, making it a promising choice of prosthetic. Presentation of case A 50-year-old male presenting with a chest lump was suspected of a chondrosarcoma of the chest wall. Preoperative pulmonary rehabilitation and smoking cessation was performed 1 month prior to surgery. After a wide excision procedure, we utilized titanium mesh as a reconstructive material. Pathology evaluation reported the examined tissue as a myxofibrosarcoma. The patient was successfully weaned off of ventilator in less than 24 h with satisfactory postoperative outcome. Discussion The various available material has each of its strengths and drawbacks and it is crucial to choose the most fitting option to acquire better postoperative outcome as well as maintaining the quality of life. The use of titanium mesh in thoracic reconstruction has not been widely explored and reported, therefore, it is important to underline its advantages and disadvantages as a potential choice for prosthetic. Conclusion Titanium mesh provides appropriate features for a chest wall reconstruction; therefore, it can be considered as a promising alternative material.
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Affiliation(s)
- Ivan Joalsen
- Division of Thoracic, Cardiac and Vascular Surgery, Mulawarman University - Abdul Wahab Sjahranie Hospital Samarinda, East Borneo, Indonesia.
| | - David Christian
- Division of Thoracic, Cardiac and Vascular Surgery, Mulawarman University - Abdul Wahab Sjahranie Hospital Samarinda, East Borneo, Indonesia
| | - Amy Rosalie
- Intern Doctor of Thoracic, Cardiac and Vascular Surgery, Abdul Wahab Sjahranie Hospital Samarinda, East Borneo, Indonesia
| | - Made Angga
- Intern Doctor of Thoracic, Cardiac and Vascular Surgery, Abdul Wahab Sjahranie Hospital Samarinda, East Borneo, Indonesia
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Huang S, Qiu P, Zhang Y, Li J, Chen W, Chen B, Liang Z, Liang Z, Luo K, Huang B. Reconstruction of the chest wall in locally advanced breast cancer with multi-disciplinary cooperation: a case report of mesh repair plus TRAM combined with DIEP chest wall reconstruction. Gland Surg 2020; 9:1048-1055. [PMID: 32953614 PMCID: PMC7475378 DOI: 10.21037/gs-20-436] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2020] [Accepted: 06/11/2020] [Indexed: 02/05/2023]
Abstract
Locally advanced breast cancer, which is defined as a malignant breast tumor that invades or adheres to the surrounding tissue, is characterized by the invasion of the chest wall and the skin surface by the tumor. Multiple lymph nodes are invaded and fuse into a mass, causing extensive axillary lymph node metastasis. However, locally advanced breast cancer does not exhibit distant metastasis. At present, in most hospitals in China and the rest of the world, this type of breast cancer is primarily managed through systematic and local treatments. However, a consensus concerning the optimal surgical method for chest wall reconstruction, which for many surgeons is a difficult and confusing procedure, has not been reached. In the past, many breast centers had used skin flap combined with hard mesh titanium alloy plate to repair the large chest wall defects. Although titanium alloy plate can maintain the stability of the chest wall, it may have a negative effect on the follow-up radiotherapy of breast cancer patients, which is a controversial method. In addition, titanium alloy mesh also has the risk of deformation and fracture. These factors will cause some hidden dangers to patient safety. According to the research, the soft mesh not only has the characteristics of satisfactory compatibility and robustness for maintaining the stability of chest wall, but also does not affect the postoperative radiotherapy of patients. Combined with the advantages of soft mesh, Our department treated a case of locally advanced breast cancer with chest wall invasion. Through cooperation between the breast surgery and thoracic surgery departments, a mesh repair plus transverse rectus abdominis myocutaneous (TRAM) combined with deep inferior epigastric perforator (DIEP) procedure was performed to remove the breast tumor and repair the large area of skin defect after surgery, and a relatively satisfactory therapeutic effect was achieved. In this case, we took two novel approaches: first, a 4-layer high-density polyethylene mesh was used to repair the defect; secondly, the inferior epigastric artery perforation was anastomosed with the thoracoacromial artery (end-to-end anastomosis) and the inferior epigastric vein perforation was anastomosed with the axillary vein (end-to-side anastomosis).
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Affiliation(s)
- Shengchao Huang
- Department of Breast Surgery, Oncology, Chest Surgery, Affiliated Hospital of Guangdong Medical University, Zhanjiang, China
| | - Pu Qiu
- Department of Breast Surgery, Oncology, Chest Surgery, Affiliated Hospital of Guangdong Medical University, Zhanjiang, China
| | - Yuanqi Zhang
- Department of Breast Surgery, Oncology, Chest Surgery, Affiliated Hospital of Guangdong Medical University, Zhanjiang, China
| | - Jianwen Li
- Department of Breast Surgery, Oncology, Chest Surgery, Affiliated Hospital of Guangdong Medical University, Zhanjiang, China
| | - Weizhang Chen
- Department of Breast Surgery, Oncology, Chest Surgery, Affiliated Hospital of Guangdong Medical University, Zhanjiang, China
| | - Baoying Chen
- Department of Breast Surgery, Oncology, Chest Surgery, Affiliated Hospital of Guangdong Medical University, Zhanjiang, China
| | - Zhu Liang
- Department of Breast Surgery, Oncology, Chest Surgery, Affiliated Hospital of Guangdong Medical University, Zhanjiang, China
| | - Zhongzeng Liang
- Department of Breast Surgery, Oncology, Chest Surgery, Affiliated Hospital of Guangdong Medical University, Zhanjiang, China
| | - Kangwei Luo
- Department of Breast Surgery, Oncology, Chest Surgery, Affiliated Hospital of Guangdong Medical University, Zhanjiang, China
| | - Baoyi Huang
- Department of Breast Surgery, Oncology, Chest Surgery, Affiliated Hospital of Guangdong Medical University, Zhanjiang, China
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