Repair of Large Chest Wall Defects: Experience with 23 Patients

Eschapasse, H; Gaillard, J; Henry, Frances; Fournial, G; Berthoumieu, F; Desrez, X

doi:10.1016/s0003-4975(10)61753-5

Cited by 43 publications

(10 citation statements)

References 22 publications

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“…There are 2 ways to cover deep chest wall defects: prosthetic or biologic mesh and/or soft tissue flaps with excellent blood supply [2,3]. Surgeons are not always able to close the defect with antilogous tissue, in the tumors which are too large and are given adequate margins [4]. …”

Section: Introductionmentioning

confidence: 99%

Primary malignant chest wall tumors: analysis of 40 patients

Bagheri

Haghi

Kalantari

et al. 2014

J Cardiothorac Surg

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BackgroundPrimary chest wall tumors originate from different constructions of thoracic wall. We report our multidisciplinary experience on primary thoracic tumor resection and thoracic reconstruction, the need to additional therapy and evaluating prognostic factors affecting survival.MethodsWe performed a retrospective review of our prospectively maintained database of 40 patients treated for malignant primary chest wall tumor from 1989 to 2009. Patients were evaluated in terms of age, sex, clinical presentation, type of imaging, tissue diagnosis methods, pathology, surgical technique, early complications, hospital mortality, prevalence of recurrence and distant metastases, additional treatment, 3 years survival and factors affecting survival.ResultsMale/Female (F/M) = 1, with median age of 43.72 years. Mass was the most common symptoms and the soft tissue sarcoma was the most common pathology. Resection without reconstruction was performed in 5 patients and Thirty-five patients (87.5%) had extensive resection and reconstruction with rotatory muscular flap, prosthetic mesh and/or cement. Overall, 12.5% (5/40) of patients received neoadjuvant therapy and 75% (30/40) of patients were treated with adjuvant therapy. The 3-year survival rate was 65%. Recurrences occurred in 24 patients (60%), 14 developed local recurrences, and 10 developed distant metastases. The primary treatment modality for both local and distant recurrences was surgical resection; among them, 10 underwent repeated resection, 9 adjuvant therapy and 5 were treated with lung metastasectomy. The most common site of distant metastasis was lung (n = 7). Factors that affected survival were type of pathology and evidence of distant metastasis.ConclusionSurgery with wide margin is the safe and good technique for treatment of primary chest wall tumors with acceptable morbidity and mortality.

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Section: Introductionmentioning

confidence: 99%

Primary malignant chest wall tumors: analysis of 40 patients

Bagheri

Haghi

Kalantari

et al. 2014

J Cardiothorac Surg

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“…Metastases in the sternum have been resected with some success and a suitable sternal prosthesis has been described (Eschapasse et al, 1981). In our patient, radical surgery was not undertaken because of evidence of an additional metastasis and the possible dissemination of tumour by autotransfusion.…”

Section: Discussionmentioning

confidence: 94%

Metastatic renal carcinoma presenting with profuse haemorrhage at cardiac surgery

Wood

Corrin

et al. 1983

Postgraduate Medical Journal

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SummaryA 62-year-old man undergoing coronary artery bypass grafting sustained profuse unexplained haemorrhage during sternal diathermy before sternotomy. Histology of tissue from the sternum suggested metastatic renal carcinoma. A primary renal tumour was subsequently identified. Sternal metastases are rare, often highly vascular, and arise particularly from thyroid or renal tumours. In the absence of angiographic evidence of an eroding aortic aneurysm, sternal metastases represent the most likely cause of unexplained haemorrhage during sternotomy.

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“…Methyl methacrylate is the most commonly used rigid alloplastic material to prevent flail chest and deformity of the thorax. [1][2][3][4]8,10,[12][13][14][15]20,21 We used stainlesssteel mesh and titanium plates in this series because they are simple to use, durable, and do not become easily dislodged with direct fixation to the bony structure. 16,17 The solidity of methyl methacrylate makes direct fixation difficult.…”

Section: Discussionmentioning

confidence: 99%

“…16,17 The solidity of methyl methacrylate makes direct fixation difficult. 20 We preferred stainless-steel mesh to a titanium plate because it is flexible and easy to mold to the shape of the defect. Stainless-steel mesh was originally developed to cover defects in the acetabulum or femur during femoral head replacement, and designed to withstand shearing stress.…”

Section: Discussionmentioning

confidence: 99%

“…2,3,6,15,20 However, Eschapasse and colleagues reported a good response to medical treatment for a Klebsiella pneumoniae wound infection in a patient who underwent reconstruction with sandwiched Marlex mesh and a methyl metacrylate plate covering the omentum. 20 An MRSA wound infection developed in one of our patients, who showed an immediate response to medical treatment, and her improvement precluded removal of the stainless-steel mesh. Symptoms of mediastinitis, sepsis, and pyothorax, or invalidity of medical treatment are indications for the immediate removal of alloplastic materials.…”

Section: Discussionmentioning

confidence: 99%

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