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DOI: 10.1055/s-0039-1694033
Anterior Chest Wall Reconstruction Using Polypropylene Mesh: A Retrospective Study
Publikationsverlauf
26. Mai 2019
21. Juni 2019
Publikationsdatum:
08. August 2019 (online)
![](https://www.thieme-connect.de/media/thoracic/202004/lookinside/thumbnails/10-1055-s-0039-1694033_195591ot-1.jpg)
Abstract
Background Anterior chest wall resection for oncological purposes is usually combined with a form of reconstruction. Most surgeons are convinced that ventrally located defects more than 4 to 5 cm require adequate reconstruction to minimize the risk of lung herniation and respiratory distress through paradox motion. We describe our in-house results of ventral chest wall reconstruction using polypropylene mesh without the use of metallic or biological implants regardless of the extent of chest wall resection.
Methods Patient selection involved ventral chest wall resection and reconstruction by polypropylene mesh for all indications such as primary tumors, metastasis, or infiltration by lung cancer from January 2008 to December 2016. Primary end point was the difference between both sides. Secondary end points were postoperative complications such as infection, surgical revision, and pulmonary complications.
Results Forty-five cases of isolated anterior reconstruction could be identified. In 34 cases, postoperative computed tomography scan of the thorax was available. Fifteen males and 19 females with a median age of 70.5 years were operated. The evaluation of maximum hemithorax diameter between operated and nonoperated sides was documented in centimeters, and the difference was documented in percentage. The mean percentage difference was 11.1% (minimum: 0.3, maximum: 44.4). In one case, wound infection with positive culture could not be treated conservatively and required operative revision and removal of the polypropylene mesh.
Conclusion Polypropylene mesh, though not rigid, can safely be used for anterior chest wall reconstruction.
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References
- 1 Sanna S, Brandolini J, Pardolesi A. , et al. Materials and techniques in chest wall reconstruction: a review. J Vis Surg 2017; 3: 95
- 2 Seder CW, Rocco G. Chest wall reconstruction after extended resection. J Thorac Dis 2016; 8 (Suppl. 11) S863-S871
- 3 Ferraro P, Cugno S, Liberman M, Danino MA, Harris PG. Principles of chest wall resection and reconstruction. Thorac Surg Clin 2010; 20 (04) 465-473
- 4 Deschamps C, Tirnaksiz BM, Darbandi R. , et al. Early and long-term results of prosthetic chest wall reconstruction. J Thorac Cardiovasc Surg 1999; 117 (03) 588-591 , discussion 591–592
- 5 Berthet JP, Gomez Caro A, Solovei L. , et al. Titanium implant failure after chest wall osteosynthesis. Ann Thorac Surg 2015; 99 (06) 1945-1952
- 6 Fabre D, El Batti S, Singhal S. , et al. A paradigm shift for sternal reconstruction using a novel titanium rib bridge system following oncological resections. Eur J Cardiothorac Surg 2012; 42 (06) 965-970
- 7 Hanna WC, Ferri LE, McKendy KM, Turcotte R, Sirois C, Mulder DS. Reconstruction after major chest wall resection: can rigid fixation be avoided?. Surgery 2011; 150 (04) 590-597
- 8 Huang H, Kitano K, Nagayama K. , et al. Results of bony chest wall reconstruction with expanded polytetrafluoroethylene soft tissue patch. Ann Thorac Cardiovasc Surg 2015; 21 (02) 119-124
- 9 Weyant MJ, Bains MS, Venkatraman E. , et al. Results of chest wall resection and reconstruction with and without rigid prosthesis. Ann Thorac Surg 2006; 81 (01) 279-285
- 10 De Palma A, Sollitto F, Loizzi D. , et al. Chest wall stabilization and reconstruction: short and long-term results 5 years after the introduction of a new titanium plates system. J Thorac Dis 2016; 8 (03) 490-498
- 11 Dingemann C, Linderkamp C, Weidemann J, Bataineh ZA, Ure B, Nustede R. Thoracic wall reconstruction for primary malignancies in children: short- and long-term results. Eur J Pediatr Surg 2012; 22 (01) 34-39
- 12 Puviani L, Fazio N, Boriani L, Ruggieri P, Fornasari PM, Briccoli A. Reconstruction with fascia lata after extensive chest wall resection: results. Eur J Cardiothorac Surg 2013; 44 (01) 125-129
- 13 Billè A, Okiror L, Karenovics W, Routledge T. Experience with titanium devices for rib fixation and coverage of chest wall defects. Interact Cardiovasc Thorac Surg 2012; 15 (04) 588-595
- 14 Spicer JD, Shewale JB, Antonoff MB. , et al. The influence of reconstructive technique on perioperative pulmonary and infectious outcomes following chest wall resection. Ann Thorac Surg 2016; 102 (05) 1653-1659
- 15 Smith MD, Campbell RM. Use of a biodegradable patch for reconstruction of large thoracic cage defects in growing children. J Pediatr Surg 2006; 41 (01) 46-49 , discussion 46–49
- 16 Marulli G, Duranti L, Cardillo G. , et al. Primary chest wall chondrosarcomas: results of surgical resection and analysis of prognostic factors. Eur J Cardiothorac Surg 2014; 45 (06) e194-e201
- 17 Levy Faber D, Fadel E, Kolb F. , et al. Outcome of full-thickness chest wall resection for isolated breast cancer recurrence. Eur J Cardiothorac Surg 2013; 44 (04) 637-642
- 18 Chapelier AR, Missana MC, Couturaud B. , et al. Sternal resection and reconstruction for primary malignant tumors. Ann Thorac Surg 2004; 77 (03) 1001-1006 , discussion 1006–1007
- 19 Mansour KA, Thourani VH, Losken A. , et al. Chest wall resections and reconstruction: a 25-year experience. Ann Thorac Surg 2002; 73 (06) 1720-1725 , discussion 1725–1726
- 20 Hameed A, Akhtar S, Naqvi A, Pervaiz Z. Reconstruction of complex chest wall defects by using polypropylene mesh and a pedicled latissimus dorsi flap: a 6-year experience. J Plast Reconstr Aesthet Surg 2008; 61 (06) 628-635
- 21 Walsh GL, Davis BM, Swisher SG. , et al. A single-institutional, multidisciplinary approach to primary sarcomas involving the chest wall requiring full-thickness resections. J Thorac Cardiovasc Surg 2001; 121 (01) 48-60
- 22 Aghajanzadeh M, Alavy A, Taskindost M, Pourrasouly Z, Aghajanzadeh G, Massahnia S. Results of chest wall resection and reconstruction in 162 patients with benign and malignant chest wall disease. J Thorac Dis 2010; 2 (02) 81-85
- 23 Berthet JP, Wihlm JM, Canaud L. , et al. The combination of polytetrafluoroethylene mesh and titanium rib implants: an innovative process for reconstructing large full thickness chest wall defects. Eur J Cardiothorac Surg 2012; 42 (03) 444-453
- 24 Lardinois D, Müller M, Furrer M. , et al. Functional assessment of chest wall integrity after methylmethacrylate reconstruction. Ann Thorac Surg 2000; 69 (03) 919-923
- 25 Miller DL, Force SD, Pickens A, Fernandez FG, Luu T, Mansour KA. Chest wall reconstruction using biomaterials. Ann Thorac Surg 2013; 95 (03) 1050-1056
- 26 Rocco G. Chest wall resection and reconstruction according to the principles of biomimesis. Semin Thorac Cardiovasc Surg 2011; 23 (04) 307-313
- 27 Rocco G. Overview on current and future materials for chest wall reconstruction. Thorac Surg Clin 2010; 20 (04) 559-562
- 28 George RS, Kostopanagiotou K, Papagiannopoulos K. The expanded role of extracellular matrix patch in malignant and non-malignant chest wall reconstruction in thoracic surgery. Interact CardioVasc Thorac Surg 2014; 18 (03) 335-339
- 29 Kilic D, Gungor A, Kavukcu S. et al. Comparison of mersilene mesh-methyl metacrylate sandwich and polytetrafluoroethylene grafts for chest wall reconstruction. J Invest Surg 2006; 19: 353-360
- 30 Iarussi T, Pardolesi A, Camplese P. et al. Composite chest wall reconstruction using titanium plates and mesh preserves chest wall function. J Thorac Cardiovasc Surg 2010; 140: 476-477