Thorac Cardiovasc Surg 2016; 64(03): 266-269
DOI: 10.1055/s-0034-1396933
How to Do It
Georg Thieme Verlag KG Stuttgart · New York

Using “Rebar” to Stabilize Rigid Chest Wall Reconstruction

Lary A. Robinson
1   Department of Thoracic Oncology (Surgery), Moffitt Cancer Center, Tampa, Florida, United States
,
Deanna M. Grubbs
1   Department of Thoracic Oncology (Surgery), Moffitt Cancer Center, Tampa, Florida, United States
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Weitere Informationen

Publikationsverlauf

14. Oktober 2014

17. November 2014

Publikationsdatum:
20. Januar 2015 (online)

Abstract

After major chest wall resection, reconstruction of the bony defect with a rigid prosthesis is mandatory to protect the underlying thoracic organs, and to prevent flail chest physiology. Although many methods have been described for chest wall reconstruction, a commonly used technique employs a composite Marlex (polypropylene) mesh with methyl-methacrylate cement sandwiched between two layers of mesh (MMS), which is tailored to the defect size and shape. In building construction, steel “rebar” is used to strengthen and reinforce masonry structures. To avoid the initial residual motion of the rigid prosthesis used to reconstruct very large defects, particularly the sternum, we devised a simple technique of adding one or more Steinmann steel pins as “rebar” to strengthen and immediately stabilize the prosthesis to the surrounding ribs and sternum. For the very large defects, particularly over the heart and great vessels, titanium mesh may also be readily added into the sandwich construction for increased strength and to prevent late prosthetic fractures. Short- and long-term results of this inexpensive modification of the MMS reconstruction technique are excellent. This modified MMS tailor-made prosthesis is only one-third the cost of the recently popular prosthetic titanium systems, takes much less operative time to create and implant, and avoids the well-described complications of late titanium bar fracture and erosion/infection as well as loosening of screws and/or titanium bars.

 
  • References

  • 1 Thomas PA, Brouchet L. Prosthetic reconstruction of the chest wall. Thorac Surg Clin 2010; 20 (4) 551-558
  • 2 Berthet JP, Canaud L, D'Annoville T, Alric P, Marty-Ane CH. Titanium plates and Dualmesh: a modern combination for reconstructing very large chest wall defects. Ann Thorac Surg 2011; 91 (6) 1709-1716
  • 3 McCormack P, Bains MS, Beattie Jr EJ, Martini N. New trends in skeletal reconstruction after resection of chest wall tumors. Ann Thorac Surg 1981; 31 (1) 45-52
  • 4 Mörsch E. Concrete-Steel Construction. 1st ed. New York: The Engineering News Publishing Co.; 1910: 204-209
  • 5 Lampl L. Chest wall resection: a new and simple method for stabilization of extended defects. Eur J Cardiothorac Surg 2001; 20 (4) 669-673