The combination of polytetrafluoroethylene mesh and titanium rib implants: an innovative process for reconstructing large full thickness chest wall defects

Berthet, Jean‐Philippe; Wihlm, Jean‐Marie; Canaud, Ludovic; Joyeux, Frédérique; Cosma, Cătălin; Hireche, Keira; Alric, Pierre; Marty-Ané, Charles-Henri

doi:10.1093/ejcts/ezs028

Cited by 53 publications

(35 citation statements)

References 21 publications

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“…In recent years, considering the favorable experiences obtained with titanium implants in other fields of prosthetic surgery (orthopedics, maxillofacial surgery), titanium systems constituted by dedicated plates, splints and screws for the reconstruction and stabilization of the chest wall (Synthes ® , STRATOS TM ) have been produced by industry and the use of titanium has been introduced in the procedures of reconstruction after demolition for neoplastic disease, to fix fractures of the thoracic cage after trauma and sternal dehiscence-diastasis and to treat malformative disease (1,2,(4)(5)(6)(7)(8)(9).…”

Section: Discussionmentioning

confidence: 99%

Chest wall stabilization and reconstruction: short and long-term results 5 years after the introduction of a new titanium plates system

Palma¹,

Sollitto²,

Loizzi³

et al. 2016

J. Thorac. Dis.

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Background:We report short and long-term results with the dedicated Synthes ® titanium plates system, introduced 5 years ago, for chest wall stabilization and reconstruction. Results: Each patient received from 1 to 10 (median 2) titanium plates/splints; median operating time was 150 min (range: 115-430 min). Post-operative course: 15 patients (55.6%) uneventful, 10 (37%) minor complications, 2 (7.4%) major complications; no post-operative mortality. Median post-operative hospital stay was 13 days (range: 5-129 days). At a median follow-up of 20 months (range: 1-59 months), 21 patients (78%) were alive, 6 (22%) died. Three patients presented long-term plates-related morbidity: plates rupture [2], pin plate dislodgment [1]; two required a second surgical look. One-year from surgery median spirometric values were: FVC 3.31 L (90%), FEV 1 2.46 L (78%), DLCO 20.9 mL/mmHg/min (76%). On 21 alive patients, 7 (33.3%) reported no pain (VRS score 0), 10 (47.6%) mild (score 2), 4 (19.1%) moderate (score 4), no-one severe (score >4); 15 (71.5%) reported none or mild, 6 (28.5%) moderate pain influencing quality of life. Conclusions: An optimal chest wall stabilization and reconstruction was achieved with the Synthes ® titanium plates system, with minimal morbidity, no post-operative mortality, acceptable operating time and post-operative hospital stay. Long-term restoration of a normal respiratory function was achieved, with minimal plates-related morbidity and chest pain. IntroductionChest wall integrity and stability are the main factors that ensure the protection of intrathoracic organs and an adequate respiratory function. The thoracic surgeon often has to deal with neoplastic, traumatic and malformative diseases affecting the chest wall and requiring the demolition and reconstruction or stabilization of the thoracic cage. For this purpose, many techniques have been proposed, including the use of various and different materials, but to date there are still no clear guidelines in the management of chest wall diseases.About 5 years ago, in 2010, a new dedicated titanium plates system (Synthes ® ) was introduced for the treatment of chest wall diseases and is nowadays available in the current practice of the thoracic surgeon (1,2). However, to the best of our knowledge, just one study about long-term outcome of patients in whom these plates were implanted, and only for post-traumatic chest wall stabilization, has been published (3). In our retrospective study we report short and long-term results obtained with this new system for the stabilization and reconstruction of the chest wall in neoplastic, traumatic and malformative diseases. Materials and methodsFrom January 2010 to December 2014, 27 consecutive patients (22 males, 5 females), with a median age of 60 years (range: 16-83 years), were treated with the dedicated Synthes ® titanium system (plates, splints and screws) for sternum and ribs reconstruction and stabilization (Synthes ® , Solothurn, Switzerland). In particular, we used both the dedicated sternal system (Sy...

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Section: Discussionmentioning

confidence: 99%

Chest wall stabilization and reconstruction: short and long-term results 5 years after the introduction of a new titanium plates system

Palma¹,

Sollitto²,

Loizzi³

et al. 2016

J. Thorac. Dis.

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“…Extensive chest wall defects that involve soft and skeletal tissues may be the end result of chest wall resection of those tumors with 2 available method for reconstruction of such defects; prosthetic or biologic mesh and/or flaps with their blood supply (3,(5)(6)(7). Recent advances in the techniques of skeletal and musculocutaneous reconstructions have facilitated the treatment of these tumors so that tumor size is not a contraindication to radical excision (8).…”

Section: Introductionmentioning

confidence: 99%

Contributing factors to the outcome of primary malignant chest wall tumors

et al. 2017

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Background: Primary malignant chest-wall tumors (PMCWTs) are a heterogeneous group of tumors.They require a special experience in designing resection and reconstruction. They account for less than 1% of all primary malignant tumors. This study is designed to clarify different factors contributing to the outcome of patients with PMCWTs in our institution. Methods: A retrospective study included 98 patients with pathology proven PMCWTs, treated at the National Cancer Institute (NCI), Cairo University, Egypt, during the past 10 years.

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“…Chest wall resection due to diverse etiologies can cause extensive chest wall defects which may involve soft and skeletal tissues. 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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The combination of polytetrafluoroethylene mesh and titanium rib implants: an innovative process for reconstructing large full thickness chest wall defects

Abstract: Our experience and initial results show that titanium rib osteosynthesis in combination with strong biologic or synthetic mesh can easily and safely be used in a one-stage procedure for the reconstruction of major chest wall defects.

Cited by 53 publications

References 21 publications

Chest wall stabilization and reconstruction: short and long-term results 5 years after the introduction of a new titanium plates system

Chest wall stabilization and reconstruction: short and long-term results 5 years after the introduction of a new titanium plates system

Contributing factors to the outcome of primary malignant chest wall tumors

Primary malignant chest wall tumors: analysis of 40 patients

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