Abstract
Chest wall resection is defined as partial or full-thickness removal of the chest wall. Significant morbidity has been recorded, with documented respiratory failure as high as 27%. Medical records of all patients who had undergone chest wall resection and reconstruction were reviewed. Patients’ demographics, length of surgery, reconstruction method, size of tumor and chest wall defect, histopathological result, complications, duration of post-operative antibiotics, and hospital stay were assessed. From 1 April 2017 to 30 April 2019, a total of 20 patients underwent chest wall reconstructive surgery. The median age was 57 years, with 12 females and 8 males. Fourteen patients (70%) had malignant disease and 6 patients (30%) had benign disease. Nine patients underwent rigid reconstruction (titanium mesh for sternum and titanium plates for ribs), 6 patients had non-rigid reconstruction (with polypropylene or composite mesh), and 5 patients had primary closure. Nine patients (45%) required closure with myocutaneous flap. Complications were noted in 70% of patients. Patients who underwent primary closure had minor complications. In total, 66.7% of patients who had closure with either fasciocutaneous or myocutaneous flaps had threatened flap necrosis. Two patients developed pneumonia and 3 patients (15%) had respiratory failure requiring tracheostomy and prolonged ventilation. There was 1 mortality (5%) in this series. In conclusion, chest wall resections involving large defects require prudent clinical judgment and multidisciplinary assessments in determining the choice of chest wall reconstruction to improve outcomes.
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Weyant MJ, Bains MS, Venkatraman E, et al. Results of chest wall resection and reconstruction with and without rigid prosthesis. Ann Thorac Surg. 2006;81:279–85.
Foroulis CN, Kleontas AD, Tagarakis G, et al. Massive chest wall resection and reconstruction for malignant disease. Onco Targets Ther. 2016;9:2349–58.
Suzuki K, Jazayeri L, Mehrara BJ, Jones DR. Chest wall reconstruction. Gen Thorac Surg. 2019;49:649–58
Spicer JD, Shewale JB, Antonoff MB, et al. The influence of reconstruction technique on perioperative pulmonary and infectious outcomes following chest wall resection. Ann Thorac Surg. 2016;102:1653–9.
Koto K, Sakabe T, Horie N, et al. Chondrosarcoma from the sternum: reconstruction with titanium mesh and a transverse rectus abdominis myocutaneous flap after subtotal sternal excision. Med Sci Monit. 2012;18:CS77–81.
Gonfiotti A, Santini PF, Campanacci D, et al. Malignant primary chest-wall tumours: techniques of reconstruction and survival. Eur J Cardiothorac Surg. 2010;38:39–45.
Harati K, Kolbenschlag J, Behr B, et al. Thoracic wall reconstruction after tumor resection. Front Oncol. 2015;5:247.
Matsumoto K, Sano I, Nakamura A, et al. Anterior chest wall reconstruction with titanium plate sandwiched between two polypropylene sheets. Gen Thorac Cardiovasc Surg. 2012;60:590–2.
Scarnecchia E, Liparulo V, Capozzi R, Ceccarelli S, Puma F, Vannucci J. Chest wall resection and reconstruction for tumours: analysis of oncological and functional outcome. J Thorac Dis. 2018;10:S1855–S1863
Anderson BO, Burt ME. Chest wall neoplasms and their management. Ann Thorac Surg. 1994;58:1774–81.
McKenna RJ, Mountain CF, McMurtrey MJ, Larson D, Stiles QR. Current techniques for chest wall reconstruction: expanded possibilities for treatment. Ann Thorac Surg. 1988;46:508–12.
Bagheri R, Haghi SZ, Kalantari MR, et al. Primary malignant chest wall tumors: analysis of 40 patients. J Cardiothorac Surg. 2014;9:106.
Lardinois D, Muller M, Furrer M, et al. Functional assessment of chest wall integrity after methylmethacrylate reconstruction. Ann Thorac Surg. 2000;69:919–23.
Mansour KA, Thourani VH, Losken A, et al. Chest wall resections and reconstruction: a 25-year experience. Ann Thorac Surg. 2002;73:1720–5.
Leuzzi N, Nachira D, Cesario A, et al. Chest wall tumors and prosthetic reconstruction: a comparative analysis on functional outcome. Thorac Cancer. 2015;6:247–54.
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Dharmaraj, B., Diong, N., Shamugam, N. et al. Chest wall resection and reconstruction: a case series of 20 patients in Hospital Kuala Lumpur, Malaysia. Indian J Thorac Cardiovasc Surg 37, 82–88 (2021). https://doi.org/10.1007/s12055-020-00972-7
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DOI: https://doi.org/10.1007/s12055-020-00972-7