Materials and techniques in chest wall reconstruction: a review

Abstract

Extensive chest wall resection and reconstruction are a challenging procedure that requires a multidisciplinary approach, including input from thoracic surgeon, plastic surgeon and oncologist. In particular chest wall neoplastic pathology is associated with high surgical morbidity and can result in full thickness defects hard to reconstruct. The goals of a successful chest wall reconstruction are to restore the chest wall rigidity, preserve pulmonary mechanic and protect the intrathoracic organs minimizing the thoracic deformity. In case of large full thickness defects synthetic, biologic or composite meshes can be used, with or without titanium plate to restore thoracic cage rigidity as like as more recently the use of allograft to reconstruct the sternum. After skeletal stability is established full tissue coverage can be achieved using direct suture, skin graft or local advancement flaps, pedicled myocutaneous flaps or free flaps. The aim of this article is to illustrate the indications, various materials and techniques for chest wall reconstruction with the goal to obtain the best chest wall rigidity and soft tissue coverage. by scapula and shoulder girdle, with the exception of defects lower than 4th rib posteriorly, with the tip of the scapula at risk to entrapment (3,12,13). With the increased availability of reconstruction materials, then, and particularly biologic materials, some surgeons proposed the reconstruction of nearly all chest wall defects, with the objective to avoid patient perception of chest wall instability (3,5,13).The primary goals of all chest wall reconstructions are to obliterate dead space, restore chest wall rigidity, preserve pulmonary mechanic, protect intrathoracic organs, provide soft tissue coverage, minimize deformity and allow patients to receive adjuvant radiotherapy if indicated (3,9). Therefore, a multidisciplinary approach, including input from thoracic surgeons, plastic surgeons, neurosurgeons as well as medical and radiation oncologists is essential.Actually several synthetic, biologic, and metallic materials are available to reconstruct the chest wall defects, but each prosthetic material has its own advantages and disadvantages and none have proven to be clearly superior (4,12). In particular, the benefit of each material and technique of reconstruction need to be weighed against to main indicators, as the risk of infection and other major complications that could be fail the reconstructive result.The recent advance in allograft and homograft production have provided new alternatives for restoring structural stability, preventing the infective complications (3,14).We would describe the main reconstructive techniques and materials more adopted on Literature reports and an overview to the incoming future of chest wall reconstruction. Synthetic, biologic and titanium meshesThe use of a metal prostheses was first reported by a French surgeon in 1909 (15), but in the 1940s better-tolerated and easier to use materials, as plastic components emerged, modifying the ...

Multidisciplinary Approach to the Management of Extensive Dermato-fibro-sarcomas Involving the Chest Wall

“…The flaps utilized were probably still the most commonly used. 6,7 Low-recurrence rates, less complication, and better survival rates demonstrated in our series could be attributed to wide oncological reconstruction of the tumors as well as appropriate methods in wound closure. All our resection margins were negative with the nearest being 1.5 cm from the Management of Extensive Dermato-fibro-sarcomas Nangole tumor margins.…”

Sternal Tumor Resection and Reconstruction Using Iliac Crest Autograft

“…Bone grafts have the advantage of being able to incorporate with revascularization and cellular repopulation, causing an increased resistance to infection. 14 Although all reported cases have produced positive outcomes, the literature regarding the use of bone grafts in sternal defects is limited. Nahabedian et al 8 reported a case in which a 7-cm sternal defect secondary to cardiac transplantation was reconstructed using fibular allograft.…”

Outcomes in Chest Wall Reconstruction Using Methyl Methacrylate Prostheses: A Review of the Literature and Case Series Utilizing a Novel Approach with Biologic Mesh

“…The cellular exposure and repopulation process are better regulated, thereby reducing risk of rejection. 15 Finally, we utilized well-vascularized soft tissue coverage to prevent exposure of our prosthesis and minimize the risk of infection. 1,[16][17][18] During preparation, the MMA is mixed to a gel-like consistency and subsequent polymerization takes 5 to 10 minutes during which the prosthesis is shaped (Lardinois et al 5 ).…”