The Best of Chest Wall Reconstruction: Principles and Clinical Application for Complex Oncologic and Sternal Defects

Abstract

he majority of chest wall defects requiring reconstruction are secondary to ablation for primary chest wall tumors, locally invasive breast or lung tumors, and metastatic lesions. 1 Other indications for chest wall reconstruction include trauma, infection, radiation-induced ulceration and necrosis leading to exposed hardware, mediastinitis, bronchopleural fistula, and empyema. 1-3 A recent review of an 81-patient cohort from 2003 to 2014 reported indications for chest wall resection and reconstruction to be primarily oncologic (61 percent of patients), and a minority for desmoid tumors (12 percent), bronchopleural fistula (4 percent), infection (9 percent), and anatomical deformity (9 percent) (Level of Evidence: Therapeutic, IV). 3 A previous study of 200 chest wall resections from 1975 to 2000 similarly highlighted reconstructive indications for primary lung cancer with extension into the chest wall (38 percent of patients), primary chest wall tumors (27 percent), breast

Long-Term Outcome of Chest Wall and Diaphragm Repair with Biological Materials

“…Back then, this kind of surgery was undertaken to treat septic complications mostly arising from infections with mycobacterium tuberculosis and was associated with considerable morbidity and mortality, mostly related to respiratory failure (2). At present, chest wall resection and reconstruction are mostly indicated for treatment of primary or secondary malignancies, including chest wall sarcoma, locally invasive lung or breast cancer and metastatic disease (3).…”

“…2 At present, chest wall resection and reconstruction are mostly indicated for treatment of primary or secondary malignancies, including chest wall sarcoma, locally invasive lung or breast cancer, and metastatic disease. 3 Chest wall reconstruction aims to preserve, restore, or improve respiratory function; conserve anatomical cavities; and upkeep postural and upper extremity support. [3][4][5] This can be achieved by utilizing a wide range of different grafts 6 made of synthetic, biological, autologous, and bioartificial materials (►Fig.…”

“…3 Chest wall reconstruction aims to preserve, restore, or improve respiratory function; conserve anatomical cavities; and upkeep postural and upper extremity support. [3][4][5] This can be achieved by utilizing a wide range of different grafts 6 made of synthetic, biological, autologous, and bioartificial materials (►Fig. 1), even though the final choice is mostly based on the treating surgeon's experiences and preferences.…”

The effect of chest wall surgery on lung volume: a new evaluation concept

“…Thoracic surgeons often deal with neoplastic, traumatic, and malformative diseases that affect the CW and require destruction, reconstruction, or stabilization of the thorax ( 1 ). CW reconstruction has developed significantly with advances in surgical techniques and the availability of various prostheses and biomaterials ( 2 , 3 ). However, each prosthetic material has advantages and disadvantages, and none has been proven superior.…”

Chest wall reconstruction in benign and malignant tumors with non-rigid materials: An overview

“…Reconstruction of the thoracic wall is indicated in case of cancers (either primary or metastatic), traumas, infections, and congenital defects: these conditions could result in functional and aesthetic impairments of the thoracic wall; thus, the aim of surgical operation is to protect intrathoracic structures, to preserve cardiac and respiratory functions, to avoid upper extremity instability, to receive radiotherapy when indicated, and to assure the best aesthetic result possible. In addition, in the case of cancer, the aim of surgery is to obtain the wider margins possible, free from malignant disease, or for palliative purposes ( 1 , 2 ).…”