Author(s): Fatima Askari1 , M.Ibrahim khan2 , Adeela hussain khan3 , Rafiya masud4, Shahrukh Mohmand5
Pages: 36-41 | DOI: https://doi.org/10.5455/pjps.1721573915
Background: Chest wall tumor resechious create large defects requiring composite reconstruction.
Objective: The objective of our study is to evaluate the outcomes of patient undergoing bony stabilization
with poly propylene mesh and soft tissue coverage with pedicled flaps.
Methodology: Comparative cross sectional study was done at Shifa hospital, Islamabad. 4 years period. All
patients who underwent composite chest wall reconstructions after tumor resections were included bony
stabilization was done with polypropylene mesh and soft tissue coverage was done with pedicles latissimuss
dorsi or transverse rectus abdominis. Variables assessed included tumor type, location and resected ribs and
flap used. Duration of hospital stay and any major or minor complications were noted.
Results: Total of 17 patients were included in the study. 11 (64.7%) were females and 6(35.3%) were males.
The causes were primary chest wall tumors in 12 (70.6%) and breast carcinoma in 5 (29.4%). Ribs along with
sternum were resected in 1 case and ribs only in 16 patients. The average number of ribs resected were 3.3.
The average chest wall defect was 161.1cm (ranging from 88cm -228 cm ). Mean postoperative hospital stay 2 2
was 7.41 days. There was no perioperative mortality.
Conclusion: Synthetic polypropylene mesh alone can be used for composite chest wall defects as it has less
infection rate than rigid prosthesis, is easy to use, safe and cost effective.
Received | 21-07-2024 Revision | 16-08-2024 Accepted | 16-08-2024
CorrespondingAuthor | Dr. FatimaAskari, Shifa International Hospitals, Islamabad
Email: fatima.askari89@gmail.com
Keywords | ChestWall, Defects, Reconstruction, pedicle Flaps, Nonrigid, Mesh.
1- Shah AA, D’Amico TA. Primary chest wall tumors. J Am Coll Surg. 2010 Mar;210(3):360-6. doi: 10.1016/j.jamcollsurg.2009.11.012. Epub 2009 Dec 22. PMID: 20193901.
2- Malathi L, Das S, Nair JTK, Rajappan A. Chest wall reconstruction: success of a team approach-a 12-year experience from a tertiary care institution. Indian J Thorac Cardiovasc Surg. 2020 Jan;36(1):44-51. doi: 10.1007/s12055-019-00841-y. Epub 2019 Jul 9. PMID: 33061093; PMCID: PMC7525737.
3- Gritsiuta AI, Bracken A, Abbas AE, Petrov RV. Complex anterior chest wall reconstruction after extensive oncologic resections: a narrative review. Shanghai Chest. 2021 Oct;5:41. doi: 10.21037/shc-21-8. Epub 2021 Oct 30. PMID: 35495182; PMCID: PMC9049198.
4- Jo GY, Ki SH. Analysis of the Chest Wall Reconstruction Methods after Malignant Tumor Resection. Arch Plast Surg. 2023 Feb 6;50(1):10-16. doi: 10.1055/s-0042-1760290. PMID: 36755660; PMCID: PMC9902099.
5- Schroeder-Finckh A, Lopez-Pastorini A, Galetin T, Defosse J, Stoelben E, Koryllos A. Anterior Chest Wall Reconstruction Using Polypropylene Mesh: A Retrospective Study. Thorac Cardiovasc Surg. 2020 Jun;68(4):341-351. doi: 10.1055/s-0039-1694033. Epub 2019 Aug 8. PMID: 31394575.
6- 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 Aug 3;9:976463. doi: 10.3389/fsurg.2022.976463. PMID: 35990091; PMCID: PMC9381953.
7-Egan KG, Emanuelli E, Butterworth JA. Chest Wall Reconstruction: A Comprehensive Analysis. Current Surgery Reports. 2022 Aug;10(8):109-18.
8-Maniscalco P, Fabbri N, Quarantotto F, Tamburini N, Cavallesco G. Titanium mesh in chest wall stabilization and reconstruction: a single center experience. Current Challenges in Thoracic Surgery. 2020 May 25;2.
9- Giordano S, Garvey PB, Clemens MW, Baumann DP, Selber JC, Rice DC, Butler CE. Synthetic Mesh Versus Acellular Dermal Matrix for Oncologic Chest Wall Reconstruction: A Comparative Analysis. Ann Surg Oncol. 2020 Aug;27(8):3009-3017. doi: 10.1245/s10434-019-08168-z. Epub 2020 Mar 9. PMID: 32152778.
10- Gonfiotti A, Salvicchi A, Voltolini L. Chest-Wall Tumors and Surgical Techniques: State-of-the-Art and Our Institutional Experience. J Clin Med. 2022 Sep 20;11(19):5516. doi: 10.3390/jcm11195516. PMID: 36233384; PMCID: PMC9573184.
11- Mansour KA, Thourani VH, Losken A, Reeves JG, Miller JI Jr, Carlson GW, Jones GE. Chest wall resections and reconstruction: a 25-year experience. Ann Thorac Surg. 2002 Jun;73(6):1720-5; discussion 1725-6. doi: 10.1016/s0003-4975(02)03527-0. PMID: 12078759.
12- 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 Jun;61(6):628-35. doi: 10.1016/j.bjps.2007.04.011. Epub 2007 Jul 25. PMID: 17656168.
13- Chang RR, Mehrara BJ, Hu QY, Disa JJ, Cordeiro PG. Reconstruction of complex oncologic chest wall defects: a 10-year experience. Ann Plast Surg. 2004 May;52(5):471-9; discussion 479. doi: 10.1097/01.sap.0000122653.09641.f8. PMID: 15096930.
14-Leuzzi G, Facciolo F. Lateral chest wall defects: reconstructive strategies. Current Surgery Reports. 2015 Jun;3:1-0.
15- Dai Z, Maihemuti M, Sun Y, Jiang R. Resection and reconstruction of huge tumors in the chest wall. J Cardiothorac Surg. 2022 May 12;17(1):116. doi: 10.1186/s13019-022-01877-9. PMID: 35551615; PMCID: PMC9097317.
16- Spicer JD, Shewale JB, Antonoff MB, Correa AM, Hofstetter WB, Rice DC, Vaporciyan AA, Mehran RJ, Walsh GL, Roth JA, Swisher SG, Sepesi B. The Influence of Reconstructive Technique on Perioperative Pulmonary and Infectious Outcomes Following Chest Wall Resection. Ann Thorac Surg. 2016 Nov;102(5):1653-1659. doi: 10.1016/j.athoracsur.2016.05.072. Epub 2016 Aug 12. PMID: 27526650.
17-Kua EH, Chia HL, Goh TL, Lim CH, Ng SW, Tan BK. A general algorithm for chest wall reconstruction based on a retrospective review. European Journal of Plastic Surgery. 2015 Jun;38:211-20.
18- Seder CW, Rocco G. Chest wall reconstruction after extended resection. J Thorac Dis. 2016 Nov;8(Suppl 11):S863-S871. doi: 10.21037/jtd.2016.11.07. PMID: 27942408; PMCID: PMC5124596.
19- Harati K, Kolbenschlag J, Behr B, Goertz O, Hirsch T, Kapalschinski N, Ring A, Lehnhardt M, Daigeler A. Thoracic Wall Reconstruction after Tumor Resection. Front Oncol. 2015 Oct 29;5:247. doi: 10.3389/fonc.2015.00247. PMID: 26579499; PMCID: PMC4625055.
20- Brito ÍM, Teixeira S, Paupério G, Choupina M, Ribeiro M. Giant chondrosarcoma of the chest wall: a rare surgical challenge. Autops Case Rep. 2020 Jun 5;10(3):e2020166. doi: 10.4322/acr.2020.166. PMID: 33344295; PMCID: PMC7703468.
21- Deschamps C, Tirnaksiz BM, Darbandi R, Trastek VF, Allen MS, Miller DL, Arnold PG, Pairolero PC. Early and long-term results of prosthetic chest wall reconstruction. J Thorac Cardiovasc Surg. 1999 Mar;117(3):588-91; discussion 591-2. doi: 10.1016/s0022-5223(99)70339-9. PMID: 10047664.
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