Original article
General thoracic
Titanium Plates and Dualmesh: A Modern Combination for Reconstructing Very Large Chest Wall Defects

https://doi.org/10.1016/j.athoracsur.2011.02.014Get rights and content

Background

The reconstruction of large full-thickness chest wall defects after resection of T3/T4 non-small cell lung carcinomas or primary chest wall tumors presents a technical challenge for thoracic surgeons and plays a central role in determining postoperative morbidity. The objective is to evaluate our results in chest wall reconstruction using a combination of expanded polytetrafluoroethylene (ePTFE) mesh and titanium plates.

Methods

Since 2006, 19 patients underwent reconstruction for wide chest wall defects using a combination of ePTFE mesh and titanium plates. The chest wall reconstruction was achieved by using a layer of 2-mm thickness ePTFE shaped to match the chest wall defect and sewed under maximum tension. The ePTFE is placed close to the lung and fixed onto the bony framework and onto the titanium plate, which is inserted on the ribs.

Results

Seventeen patients underwent a complete R0 resection with the removal of 3 to 9 ribs (mean, 4.8 ribs), including the sternum in 7 cases. Reconstruction required 1 to 4 horizontal titanium bars (mean, 1.7 bars). In 1 patient, a vertical titanium device was implanted for a large posterolateral defect. There were 2 cases of infection, which required explantation of the osteosynthesis system in 1 patient. One patient had partial skin necrosis that required prompt debridement. One patient had a major complication in the form of respiratory failure.

Conclusions

Our experience and initial results show that titanium rib osteosynthesis in combination with Dualmesh can easily and safely be used in a one-stage procedure for major chest wall defects.

Section snippets

Material and Methods

From October 2006 to January 2010, 19 patients underwent a large chest wall resection. We employed the combination of Dualmesh and titanium plates as our procedure of choice for large thoracic wall defect reconstructions. This study was approved by our Ethics Committee, and individual consent was obtained in each cases.

In all patients, before resection, we systematically performed computed tomography scans of the thorax, abdomen, and brain; and none of these patients had extrathoracic

Results

Between 2006 and 2010, 19 patients (10 women) with a median age of 58 years (range, 34 to 72 years) with chest wall invasion from either primary or secondary chest wall tumors or T3/T4 NSCLC were treated at our institution. Histology, neoadjuvant therapy, resection quality, and tumor classification are reported in Table 1. There were 11 NSCLC patients, all of whom underwent neoadjuvant chemotherapy and preoperative radiation therapy. The tumor was classified as T4 in 8 cases, thereby meaning

Comment

Surgery represents the cornerstone of treatment in primary chest wall tumor and NSCLC with parietal involvement but no lymph node involvement (N0). The main objective of chest wall resection is to perform a radical R0 en-bloc resection. The main basis of chest wall reconstruction is summarized in the introduction according to the literature [3, 4, 5]. The importance of radical surgery is well known and has been demonstrated by many authors [1, 2, 3, 5]. Since Downey and colleagues [6] stated

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