Chest wall resection and reconstruction: a case series of 20 patients in Hospital Kuala Lumpur, Malaysia

Dharmaraj, Benedict; Diong, Nguk Chai; Shamugam, Navindra; Sathiamurthy, Narasimman; Zainal, Hamidah Mohd; Chai, Siew Cheng; Koh, Khai Luen; Zain, Mohammad Ali Mat; Basiron, Normala

doi:10.1007/s12055-020-00972-7

Cited by 2 publications

(3 citation statements)

References 13 publications

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“… 3 In our center, rigid reconstruction was the method of choice for anterolateral chest wall defect of more than 10cm in diameter and when more than 3 ribs are resected. 4 Titanium plates were used in all our cases with combination of titanium mesh (central defect) and composite mesh (thoracoabdominal defect). Titanium plates are chosen for its advantage as it allows a more physiologic chest movement, has good tensile strength, and resists infection.…”

Section: Discussionmentioning

confidence: 99%

Challenges in Complex Oncological Chest Wall Reconstruction with Free Anterolateral Thigh Flap and Titanium Rib Plate

Chai

Shamugam

Basiron

et al. 2023

Indian J Plast Surg

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Extensive chest wall tumor resection and reconstruction possess a formidable challenge and require good collaboration between thoracic and reconstructive surgeons. In this article, we reviewed our experience in six consecutive cases requiring complex chest wall resection and reconstruction with titanium rib plates and free anterolateral thigh fasciocutaneous flap with fascia lata with a minimum 24 months follow-up postoperatively.Six patients with a mean age of 54 were diagnosed to have locally advanced malignant (n = 5) and benign (n = 1) tumors. They underwent wide local excision with a mean of six ribs resected, and the average size of the soft tissue defect was 389cm2. The integrity of the thoracic cage was restored by using titanium rib plates. Fascia lata was harvested along with free anterolateral thigh fasciocutaneous flap to achieve near airtight closure of pleural space for soft tissue coverage. Two patients required early flap exploration with successful flap salvage. One flap failure was reported on postoperative day 11 due to a mechanical cause and a redo surgery was required. With an average stay of 3 days in the intensive care unit, no perioperative pulmonary complications were recorded.Complex oncological chest wall resection and reconstruction with titanium rib plates and free anterolateral thigh fasciocutaneous flap with fascia lata yielded satisfactory aesthetic and physiological functional outcomes.

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Section: Discussionmentioning

confidence: 99%

Challenges in Complex Oncological Chest Wall Reconstruction with Free Anterolateral Thigh Flap and Titanium Rib Plate

Chai

Shamugam

Basiron

et al. 2023

Indian J Plast Surg

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“…Proper cell attachment as well as migration into the scaffold were observed for all three materials. From a material point of view, it seems to be favorable to include a bone-mimetic calcium-containing phase, 44 because chest wall reconstruction normally includes rib, 7 and somtimes also sternum resection. 45…”

Section: Discussionmentioning

confidence: 99%

“…4,5 Reconstruction based on titanium combined with biologicals, such as fasciocutaneous and myocutaneous flaps, is a conventional technique which is reported to be very effective. 6,7 Other methods include less rigid grafts like polypropylene [7][8][9] or a prolene mesh. 10 In contrast, rigidity is added with grafts made of methyl acrylate.…”

Section: Introductionmentioning

confidence: 99%

Hybrid nanocomposite as a chest wall graft with improved vascularization by copper oxide nanoparticles

et al. 2022

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Chest wall repair can be necessary after tumor resection or chest injury. In order to cover or replace chest wall defects, autologous tissue or different synthetic materials are commonly used, among them the semi-rigid gold standard Gore-Tex® and prolene meshes. Synthetic tissues include composite materials with an organic and an inorganic component. On the basis of previously reported hybrid nanocomposite poly-lactic-co-glycolic acid amorphous calcium phosphate nanocomposite (PLGA/aCaP), a CuO component was incorporated to yield (60%/35%/5%). This graft was tested in vitro by seeding with murine adipose-derived stem cells (ASCs) for cell attachment and migration. The graft was compared to PLGA/CaCO3 and PLGA/hydroxyapatite, each providing the inorganic phase as nanoparticles. Further characterization of the graft was performed using scanning electron microscopy. Furthermore, PLGA/aCaP/CuO was implanted as a chest wall graft in mice. After 4 weeks, total cell density, graft integration, extracellular matrix components such as fibronectin and collagen I, the cellular inflammatory response (macrophages, F4/80 and lymphocytes, CD3) as well as vascularization (CD31) were quantitatively assessed. The nanocomposite PLGA/aCaP/CuO showed a good cell attachment and cells migrated well into the pores of the electrospun meshes. Cell densities did not differ between PLGA/aCaP/CuO and PLGA/CaCO3 or PLGA/hydroxyapatite, respectively. When applied as a chest wall graft, adequate stability for suturing into the thoracic wall could be achieved. Four weeks post-implantation, there was an excellent tissue integration without relevant fibrotic changes and a predominating collagen I matrix deposition within the graft. Slightly increased inflammation, reflected by increased infiltration of macrophages could be observed. Vascularization of the graft was significantly enhanced when compared with PLGA/aCaP (no CuO). We conclude that the hybrid nanocomposite PLGA/aCaP/CuO is a viable option to be used as a chest wall graft. Surgical implantation of the material is feasible and provides stability and enough flexibility. Proper tissue integration and an excellent vascularization are characteristics of this biodegradable material.

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Chest wall resection and reconstruction: a case series of 20 patients in Hospital Kuala Lumpur, Malaysia

Cited by 2 publications

References 13 publications

Challenges in Complex Oncological Chest Wall Reconstruction with Free Anterolateral Thigh Flap and Titanium Rib Plate

Challenges in Complex Oncological Chest Wall Reconstruction with Free Anterolateral Thigh Flap and Titanium Rib Plate

Hybrid nanocomposite as a chest wall graft with improved vascularization by copper oxide nanoparticles

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