Reconstruction of the thoracic wall—long-term follow-up including pulmonary function tests

Daigeler, Adrien; Druecke, D.; Hakimi, Mitra; Duchna, Hans‐Werner; Goertz, Ole; Homann, H.-H.; Lehnhardt, Marcus; Steinau, Hans-Ulrich

doi:10.1007/s00423-008-0400-9

Cited by 59 publications

(69 citation statements)

References 37 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…They are simple to use and usually well tolerated when completely covered by viable tissue, provide a barrier that prevents fluid and air moving between pleural and subcutaneous space and propose a scaffold for the in-growth of regenerative connective tissue colonizing their outer and inner surfaces. Some authors reported an infection rate between 10% and 25% for synthetic meshes and the needs to remove the infected mesh to resolve the problem (8,16). In these cases a Vicryl mesh could be considered due to its inert, nonantigenic, biocompatible and slowly absorbing material or a biologic mesh as like as bovine pericardium prosthesis (Figure 2), that have the same tensile strength and elasticity as those synthetic, but some proper physiologic properties of resistance to infection and contamination.…”

Section: Synthetic Biologic and Titanium Meshesmentioning

confidence: 99%

“…Chest wall defects generally result from resection of primary chest wall tumours, locally-invasive malignancies or metastatic lesions (4). The optimal approach to reconstruction is determined by the size, location and depth of the defect, viability of the surrounding tissue and prior operative procedures (5), because in case of neoplastic pathology it's mandatory to obtain oncologic margins not compromised and this could be result in large full-thickness defects (6), often resulting in a significant morbidity and mortality for the patient (3,(7)(8)(9)(10).…”

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Materials and techniques in chest wall reconstruction: a review

et al. 2017

View full text Add to dashboard Cite

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 ...

show abstract

Section: Synthetic Biologic and Titanium Meshesmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Materials and techniques in chest wall reconstruction: a review

et al. 2017

View full text Add to dashboard Cite

show abstract

“…3 gezeigten, kombinierten "vertical/ transverse rectus abdominis muscle"-Lappen (V/TRAM) durchgeführt werden. Bei exulzeriertem Mammakarzinom (a) erfolgte in diesem Fall zunächst die Thoraxwandresektion und daraufhin die Rekonstruktion mit gestieltem VRAM/TRAM-Ankerlappen [22,24], gestielt an den superioren epigastrischen Gefäßen. Zusätzlich erfolgte eine modifizierte Abdominoplastik mit Nabelneueinpflanzung (b) zum Verschluss des Hebedefekts.…”

Section: Operative Möglichkeitenunclassified

“…Die wenigen zu diesem Thema vorliegenden Untersuchungen konnten belegen, dass auch ausgedehnte Eingriffe, wie Thoraxwandresektionen und -rekonstruktionen die Lebensqualität der Patienten verbessern können. Knapp die Hälfte der in palliativer Absicht operierten Patienten lebte nach der Operation noch länger als 2 Jahre [22]. Die operativen Therapien sollen für den Patienten eine kurze Hospitalisierungsdauer mit rascher Rekonvaleszenz beinhalten, um die restliche Lebenszeit ohne Wundkomplikationen, mög-lichst im heimischen Umfeld verbringen zu können.…”

Section: Bisherigeunclassified

Palliative plastische Chirurgie im multimodalen Therapiekonzept

et al. 2013

View full text Add to dashboard Cite

show abstract

“…5) Moreover, data available in the literature report mainly on survival, recurrence and metastasis rates whereas reports focused on the impact on pulmonary function are scarce. 6,7) As well, no follow-up studies report about pulmonary assessment after G-Tex reconstruction.…”

Section: To the Editormentioning

confidence: 99%

Chest Wall Reconstruction: Impact of Gore-Tex^|^#174; Dual-Mesh Prosthesis on Respiratory Function

Leuzzi

Cesario

Novellis

et al. 2012

Ann Thorac Cardiovasc Surg

View full text Add to dashboard Cite

We read with great interest the report by Akiba et al. 1) reporting on a series of chest wall reconstruction using polytetrafluoroethylene (PTFE) prosthesis Gore-Tex® dual-mesh. Nowadays, chest wall reconstruction has become a standard procedure for thoracic surgeons and the availability of synthetic meshes with good biocompatibility enables to cover defects after extensive resections in a one-stage procedure.2) In the English literature, it is widely accepted that bony chest wall reconstruction with either polypropylene mesh or PTFE yields satisfactory results in most patients. 3,4) Concerning the PTFE prosthesis, Gore-Tex© dual-mesh (G-Tex), composed by two distinct surfaces (smoother surface designed for minimal tissue attachment, and patterned, indented surface designed for active tissue incorporation) has been successfully used in the repair and reconstruction of hiatus and the abdominal wall hernias; however, only few reports described a reconstruction of the bony chest wall with a G-Tex prosthesis. 5)Moreover, data available in the literature report mainly on survival, recurrence and metastasis rates whereas reports focused on the impact on pulmonary function are scarce.6,7) As well, no follow-up studies report about pulmonary assessment after G-Tex reconstruction.In the period between 01/98 and 12/10, we have performed a chest wall resection in 175 patients affected by primary in 111 and secondary chest wall tumors in 64 cases. For the reconstruction of the surgical defect, prostheses were used in 39 patients: 31 treated with G-Tex and 8 with the vicryl patch.In the G-Tex subset, there were 15 primary and 16 secondary tumors. Rib resection was performed in 27 cases, while in 11 patients, it was the sternum to be resected. A resection of quotas of pulmonary parenchyma was associated in 12 patients, always to an extent limited to the amount necessary to guarantee safe margins. Mean hospital stay was 7.9 days (range 3-21 days); the morbidity rate was 12.9% (4 patients), lower than that reported in Reference 1 (45.4%). Paradoxical respiration did not occur; perioperative mortality was nil.After communication to the IRB, we have data mined the hospital records of those patients in the G-Tex group and reviewed their pre-and post-operative pulmonary functionality. Only a moderate negative trend has been detected: in fact, the mean FEV1, pre-operatively at 87.1 ± 5.7 %, slightly decreased to a value of 82.3 ± 8.7 % in the post-op period with no significant differences (p: 0.74).Our results are in line with those reported elsewhere 8) confirming that the reconstruction of the chest wall after resection with the G-Tex prosthesis does not impair the lung functionality significantly. We would really appreciate the Authors' reflections and reaction on this at the light of the respiratory functional assessment related to mesh repair in their series.

show abstract

Reconstruction of the thoracic wall—long-term follow-up including pulmonary function tests

Abstract: Thoracic wall reconstruction provides sufficient thoracic wall stability to maintain pulmonary function, but postoperative pain and sensation disorders are considerable. However, chest wall repair can contribute to palliation and even cure after full-thickness resections.

Cited by 59 publications

References 37 publications

Materials and techniques in chest wall reconstruction: a review

Materials and techniques in chest wall reconstruction: a review

Palliative plastische Chirurgie im multimodalen Therapiekonzept

Chest Wall Reconstruction: Impact of Gore-Tex^|^#174; Dual-Mesh Prosthesis on Respiratory Function

Contact Info

Product

Resources

About