Ten-Year Experience of Chest Wall Reconstruction: Retrospective Review of a Titanium Plate MatrixRIB™ System

Abstract

Chest wall tumor resection can result in a large defect that can pose a challenge in reconstruction in restoring chest wall contour, maintaining respiratory mechanics, and improving cosmesis. Titanium plates were first introduced for treating a traumatic flail chest, which yielded promising results in restoring chest wall stability. Subsequently, the applications of titanium plates in chest wall reconstruction surgery were demonstrated in case reports and series. Our center has adopted this technique for a decade, and patients are actively followed up after operation. Here, we retrospectively analyze our 10-year experience of using titanium plates and other reconstruction approaches for chest wall reconstruction, in terms of clinical outcomes, complications, and reasons for reoperation to determine long-term safety and efficacy. Thirty-eight patients who underwent chest wall resection and reconstruction surgery were identified. Of these, 11 had titanium plate insertion, 11 had patch repair or flap reconstruction, and the remaining 16 had primary closure of defects. Chest wall reconstruction using titanium plate(s) and patch repair (with or without flap reconstruction) was associated with larger chest wall defects and more sternal resections than primary closure. Subgroup analysis also showed that reconstruction by the titanium plate technique was associated with larger chest wall defects than patch repair or flap reconstruction [286.80 cm2 vs. 140.91 cm2 (p = 0.083)]. There was no 30-day hospital mortality. Post-operative arrhythmia was more commonly seen following chest wall reconstruction compared with primary closure (p = 0.041). Furthermore, more wound infections were detected following the use of titanium plate reconstruction compared with the patch repair (with or without flap reconstruction) approach (p = 0.027). In conclusion, the titanium plate system is a safe, effective, and robust approach for chest wall reconstruction surgery, especially in tackling larger defect sizes.

Should wide chest wall resections and reconstruction intimidate thoracic surgeons?

“…Wong et al [13] reported no in-hospital or early postoperative mortality in their 10-year experience with long-term outcomes after chest wall reconstructions with titanium plates. They emphasized that titanium plates provide a safe and effective reconstruction, and long-term complications are rare and manageable.…”

“…[11] The titanium plate's shape is user-friendly and ergonomic, which can lessen the likelihood of a prosthesis fracture. [12,13] Better chest wall reconstruction is made possible by the titanium plate, which imitates natural anatomy and physiology to address greater deficiencies and lower the risk of respiratory failure. [13] The improvements comprise more accurate preoperative localization of rib fractures utilizing ultrasonography or three-dimensional computed tomography reconstruction technologies, as well as more reliable rib fixation using specifically created plating systems.…”

“…[12,13] Better chest wall reconstruction is made possible by the titanium plate, which imitates natural anatomy and physiology to address greater deficiencies and lower the risk of respiratory failure. [13] The improvements comprise more accurate preoperative localization of rib fractures utilizing ultrasonography or three-dimensional computed tomography reconstruction technologies, as well as more reliable rib fixation using specifically created plating systems. [14] Selective metal laser sintering three-dimensional prototyping technology has yielded encouraging results for surgeons who want to increase the adaption of the reconstruction material to respiratory mechanics and generate the material that is closest to the original.…”

“…Achieving skeletal stabilization is the primary objective of rebuilding the defect following chest wall excision. [4,13,14] A primary closure can be used to successfully restore the chest wall if the skeletal stability is intact. Autologous muscles are used for primary closure, such as the pectoralis major, rectus abdominus, latissimus dorsi, and external oblique or trapezius muscles.…”

Progress in chest wall surgery

“…Tumor resection is a mature technology, and recent advances mainly focus on the reconstruction materials [45,46] . Matrix RIB was originally used as a material for fixation of rib fracture [47] , but recent studies ~ 164 ~ have found that this material can be easily used in chest wall reconstruction [48,49] . Another interesting material is digital material [50] .…”