Reconstruction of massive chest wall defects: A 20-year experience

Corkum, Joseph P.; Garvey, Patrick B.; Baumann, Donald P.; Abraham, Jasson T.; Li, Jun; Hofstetter, Wayne L.; Butler, Charles E.; Clemens, Mark W.

doi:10.1016/j.bjps.2020.02.010

Cited by 13 publications

(27 citation statements)

References 40 publications

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“…The large resectional surface area is biomechanically destabilizing to both the abdominal wall and chest wall, predisposing the patient to reduced ventilatory capacity, paradoxical chest wall motion, and reduced core strength. 7 , 10 An isolated chest wall defect of this size could be reconstructed using standard titanium spanning rib plates; however, because the defect also included the inferior sternum, there was no anterior fixation point for the rib plates. Therefore, a custom prosthesis addressing both the resected ribs and the sternum was necessary.…”

Section: Discussionmentioning

confidence: 99%

Custom 3D-printed Titanium Implant for Reconstruction of a Composite Chest and Abdominal Wall Defect

Danker

Mericli

Rice

et al. 2021

Plastic and Reconstructive Surgery - Global Open

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Background: Three-dimensional (3D) printing of implantable materials is a recent technological advance that is available for clinical application. The most common medical application of 3D printing in plastic surgery is in the field of craniomaxillofacial surgery. There have been few applications of this technology in other areas. Methods: Here, we discuss a case of a large, symptomatic composite thoracic and abdominal defect resulting from the resection of a chondrosarcoma of the costal marginand sections of the abdominal wall, diaphragm, and sternum. The initial and second attempts at reconstruction failed, resulting in a massive hernia. Given the size of the defect, the contiguity with a large abdominal wall defect, and the high risk of recurrence, a rigid thoracic reconstruction was essential to durably repair the thoracic hernia and serve as a scaffold to which both the diaphragm and the abdominal mesh could be secured. A custom-made plate offered the most durable and anatomically accurate reconstruction in this particular clinical scenario. This technology was used in concert with a single section of coated mesh for reconstruction of the diaphragm, chest wall, and abdominal wall. Results: There were no post-operative complications. The patient has improvement of his symptoms and increased functional capacity. There is no evidence of hernia recurrence 1.5 years after repair. Conclusions: 3D printing technology proved to be a useful and effective application for reconstruction of this large thoracic defect involving the costal margin. It is an available technology that should be considered for reconstruction of rigid structures with defect-specific precision.

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Section: Discussionmentioning

confidence: 99%

Custom 3D-printed Titanium Implant for Reconstruction of a Composite Chest and Abdominal Wall Defect

Danker

Mericli

Rice

et al. 2021

Plastic and Reconstructive Surgery - Global Open

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“…MV is a common shortterm intervention following radical chest wall resection in humans. 35 While published information is limited, available studies suggest that postoperative complications are common, but short-term mortality rates are comparatively low (⩽7%). [35][36][37][38] A recent publication of 59 human patients with chest wall reconstruction following the resection of 5-10 ribs reported an average of 3.9 ventilator-dependent days, difficulty weaning in 3.3% and a 30-day survival rate of 96.6%.…”

Section: Discussionmentioning

confidence: 99%

“…35 While published information is limited, available studies suggest that postoperative complications are common, but short-term mortality rates are comparatively low (⩽7%). [35][36][37][38] A recent publication of 59 human patients with chest wall reconstruction following the resection of 5-10 ribs reported an average of 3.9 ventilator-dependent days, difficulty weaning in 3.3% and a 30-day survival rate of 96.6%. 35 In the cat in this report, MV was similarly intended to serve as a transient intervention to allow time for strengthening and adaptation of the remaining inspiratory musculature.…”

Section: Discussionmentioning

confidence: 99%

“…[35][36][37][38] A recent publication of 59 human patients with chest wall reconstruction following the resection of 5-10 ribs reported an average of 3.9 ventilator-dependent days, difficulty weaning in 3.3% and a 30-day survival rate of 96.6%. 35 In the cat in this report, MV was similarly intended to serve as a transient intervention to allow time for strengthening and adaptation of the remaining inspiratory musculature. However, in retrospect, it is unlikely that this approach would ultimately have been successful.…”

Section: Discussionmentioning

confidence: 99%

“… 35 – 38 A recent publication of 59 human patients with chest wall reconstruction following the resection of 5–10 ribs reported an average of 3.9 ventilator-dependent days, difficulty weaning in 3.3% and a 30-day survival rate of 96.6%. 35 …”

Section: Discussionmentioning

confidence: 99%

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Ventilatory failure in a cat following radical chest wall resection for feline injection site sarcoma

Bilko

Veytsman

Amsellem

et al. 2021

Journal of Feline Medicine and Surgery Open Reports

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Case summary A 12-year-old spayed female domestic shorthair cat presented for chest wall resection and radiation therapy following incomplete surgical excision of a feline injection site sarcoma. A CT scan for surgical planning was performed under general anesthesia and showed extensive tumor infiltration of the soft tissues of the right thorax. The cat recovered uneventfully from this anesthetic event. Nineteen days later, the patient was reanesthetized for forequarter amputation plus radical chest wall resection, including ribs 3–8 and all associated soft tissues plus adjacent spinous processes. Postoperatively, the patient developed acute respiratory failure secondary to hypoventilation. The cat was mechanically ventilated for 12 h prior to being successfully weaned from the ventilator. However, the improvement was transient and mechanical ventilation was reinitiated 6 h later owing to respiratory fatigue. On the second day, the cat developed unexplained central nervous system signs and was euthanized. Relevance and novel information To our knowledge, this is the first case report to describe ventilatory failure secondary to radical chest wall resection in a cat. Hypoventilation with subsequent need for mechanical ventilation is a potential complication that should be considered during preoperative planning in patients requiring extensive chest wall resections.

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Surgical management of locally advanced breast cancer: Recommendations of the Brazilian Society of Surgical Oncology

Vieira

Andrade

Vieira

et al. 2022

Journal of Surgical Oncology

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The Brazilian Society of Surgical Oncology organized a group of oncological surgeons to discuss surgical aspects associated with locally advanced breast carcinoma. This article reviews the indications, different surgeries (thoracoabdominal or myocutaneous flaps), and associated complications. It discusses special conditions such as invasion of the chest wall and interscapular thoracic disarticulation. It makes recommendations based on the literature regarding clinical findings, tumor conditions, response to neoadjuvant therapy, choice of flaps in surgery, and tumor biology.

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Reconstruction of massive chest wall defects: A 20-year experience

Cited by 13 publications

References 40 publications

Custom 3D-printed Titanium Implant for Reconstruction of a Composite Chest and Abdominal Wall Defect

Custom 3D-printed Titanium Implant for Reconstruction of a Composite Chest and Abdominal Wall Defect

Ventilatory failure in a cat following radical chest wall resection for feline injection site sarcoma

Surgical management of locally advanced breast cancer: Recommendations of the Brazilian Society of Surgical Oncology

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