Complications, Pitfalls, and Outcomes After Chest Wall Reconstruction

Netscher, David T.; Izaddoost, Shayan A.; Sandvall, Brinkley K.

doi:10.1055/s-0031-1275175

Cited by 20 publications

(17 citation statements)

References 44 publications

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“…The probable explanation is, as previously documented, that signs of lung hernia, in the form of bulging with cough or palpable chest wall defects, may or may not be associated with symptoms, sometimes being even misleading. Treatment for an acute systolic heart failure or urgent intubation and embolisation for hemoptysis have been reported as well [4, 5]. In the presented patient, although the diagnosis of the hernia was obtained four months after surgery, the interval between the two operations was almost two years.…”

Section: Discussionmentioning

confidence: 78%

Surgical Repair of the Postoperative Lung Hernia by Combining Mesh Interposition and Chest Wall Stabilization by Using Synthes Plates: A Novel Technique

Subotic

Wiese

Hojski

et al. 2019

Case Reports in Surgery

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Several technical points for postoperative lung hernia repair are still not fully elucidated. We present an original technical solution to deal with this complication. In a 68-year-old female, the lung hernia was confirmed 5 months after the partial left-sided chest wall and scapula angle resection with primary Mersilene mesh reconstruction for elastofibroma. The patient refused the proposed surgical correction, being only slightly limited in daily activities. The symptoms persisted under analgetic therapy till the moment when patient’s daily activities became critically limited, 22 months after surgery. The repeated chest CT showed a slight increase in hernia size with no signs of tumour recurrence, so that reoperation was planned. After the exposure of the mesh region, a lung protrusion (4×3 cm) along the anterolateral edge of the mesh was confirmed. By careful dissection, the mesh was separated from a firmly adherent lung and removed. After adhaesiolysis and complete lung liberation, a wedge resection of the afunctional lung tissue of the lingula was done, just in the region of contact with the mesh. After the chest tube insertion, the chest wall defect was reconstructed by using a Mersilene mesh, and the final chest wall stabilization was done by the fixation of two Synthes plates (DePuy Synthes J&J) over the 5th and 6th ribs. The postoperative course was uneventful. One year after the operation, the patient was in good general condition, without the need for analgesics. To the best of our knowledge, the described technique is the original way of dealing with postoperative lung hernia. We find it efficient as a prevention of potential serious hernia-related complications.

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Section: Discussionmentioning

confidence: 78%

Surgical Repair of the Postoperative Lung Hernia by Combining Mesh Interposition and Chest Wall Stabilization by Using Synthes Plates: A Novel Technique

Subotic

Wiese

Hojski

et al. 2019

Case Reports in Surgery

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“…[2] Finally, vascularized tissue must be provided to cover a thoracic defect with healthy soft-tissue that is pedicled or free of muscle coverage. Pedicled muscular and musculocutaneous flaps of the latissimus dorsi are commonly used because they may provide a source of reliable, vascularized tissue that enhances the eradication of the infection and that allows for the complete filling of the defect and for the reconstruction the chest wall; [3,6,7] however, close attention should be directed to whether the vascular pedicle was included in the radiation field and, if so, whether the vessels are patent and what the quality of the soft tissue that is surrounding those vessels is. These considerations can affect the blood flow to the flap after reconstruction, even when the vessels are patent, via the kinking of the pedicle when it is rotated through the fibrotic tissue.…”

Section: Discussionmentioning

confidence: 99%

Free vastus lateralis musculocutaneous flap transfer for radiation-induced chest wall fistula combined with osteomyelitis

Xia

Shen

et al. 2019

Medicine

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Rationale: Chronic chest wall fistula is a refractory and agonizing disease that results from multiple predisposing etiologies, including radiation-induced damage. Successful management remains challenging when this condition is combined with osteomyelitis, and a limited number of reports have been published in the literature concerning this management. Patient concerns: Two Chronic chest wall fistula patients were selected to undergo surgery in our hospital because they could not be cured by conventional therapy for several years. One is a 74-year-old female who has received a right radical mastectomy and had radiation therapy 23 years ago; the other is a 59-year-old male who underwent a excision of thyroid cancer and had chemoradiation therapy 20 years earlier. Diagnosis: Both patients were diagnosed with radiation-induced chest wall fistula combined with osteomyelitis. Interventions: After total resection of the diseased chest walls, both patients underwent free vastus lateralis musculocutaneous flap transfers, in which the vessels were microvascularly anastomosed to the transverse carotid artery and vein via a subcutaneous tunnel or a direct incision. Histologic evaluations of the specimens demonstrated inflammation and osteomyelitis. Outcomes: The patients recovered very well and currently have no recurrence of chest wall fistulae during the postoperative follow-up. Lessons: It is crucial to not only completely resect chest wall fistulae and the surrounding diseased tissues but also reconstruct the chest wall. Thus, the use of the free vastus lateralis musculocutaneous flap transfer method for radiation-induced chest wall fistulae, combined with osteomyelitis, is a useful option for treatment and is also a feasible and efficient surgical procedure with promising results.

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“…The decision as to whether synthetic nets should be utilized depends on several factors, which include not only defect area and depth but also rigidity of the chosen flap coverage, location, wound contamination, and skin texture after previous radiation. It is widely accepted that defects exceeding more than four ribs at the lateral chest wall are associated with higher risks of herniation and paradox breathing and therefore should additionally be reconstructed with synthetic nets ( 8 , 19 – 22 ). However, the closer the defect to the apex of the thoracic wall, the more suspension is provided by the sternum, scapula, and clavicula, and even larger defects might be reconstructed without additional synthetic material ( 23 ).…”

Section: Thoracic Wall Reconstruction With Mesh and Composite Implantmentioning

confidence: 99%

Thoracic Wall Reconstruction after Tumor Resection

et al. 2015

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IntroductionSurgical treatment of malignant thoracic wall tumors represents a formidable challenge. In particular, locally advanced tumors that have already infiltrated critical anatomic structures are associated with a high surgical morbidity and can result in full-thickness defects of the thoracic wall. Plastic surgery can reduce this surgical morbidity by reconstructing the thoracic wall through various tissue transfer techniques. Sufficient soft-tissue reconstruction of the thoracic wall improves quality of life and mitigates functional impairment after extensive resection. The aim of this article is to illustrate the various plastic surgery treatment options in the multimodal therapy of patients with malignant thoracic wall tumors.Materials and methodsThis article is based on a review of the current literature and the evaluation of a patient database.ResultsSeveral plastic surgical treatment options can be implemented in the curative and palliative therapy of patients with malignant solid tumors of the chest wall. Large soft-tissue defects after tumor resection can be covered by local, pedicled, or free flaps. In cases of large full-thickness defects, flaps can be combined with polypropylene mesh to improve chest wall stability and to maintain pulmonary function. The success of modern medicine has resulted in an increasing number of patients with prolonged survival suffering from locally advanced tumors that can be painful, malodorous, or prone to bleeding. Resection of these tumors followed by thoracic wall reconstruction with viable tissue can substantially enhance the quality of life of these patients.DiscussionIn curative treatment regimens, chest wall reconstruction enables complete resection of locally advanced tumors and subsequent adjuvant radiotherapy. In palliative disease treatment, plastic surgical techniques of thoracic wall reconstruction provide palliation of tumor-associated morbidity and can therefore improve patients’ quality of life.

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Complications, Pitfalls, and Outcomes After Chest Wall Reconstruction

Cited by 20 publications

References 44 publications

Surgical Repair of the Postoperative Lung Hernia by Combining Mesh Interposition and Chest Wall Stabilization by Using Synthes Plates: A Novel Technique

Surgical Repair of the Postoperative Lung Hernia by Combining Mesh Interposition and Chest Wall Stabilization by Using Synthes Plates: A Novel Technique

Free vastus lateralis musculocutaneous flap transfer for radiation-induced chest wall fistula combined with osteomyelitis

Thoracic Wall Reconstruction after Tumor Resection

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