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Chest Wall Resection and Reconstruction for Thoracic Tumor Invading the Chest Wall: A Report of 12 Cases  [cached]
Shaohua MA,Luyan SHEN,Senkai LI,Xiaotian SHI
Chinese Journal of Lung Cancer , 2012, DOI: 10.3779/j.issn.1009-3419.2012.02.05
Abstract: Background and objective Tumor involving the chest wall is a common clinical event, and if there are no distant metastases, complete resection of tumor and involved chest wall can give excellent results. The aim of this study is to report experience with chest wall resection and reconstruction (CWRR) for 12 patients who suffered thoracic malignant tumor involving chest wall, including the artificial materials used for reconstruction, soft tissue coverage, and our multidisciplinary CWRR approach. Methods All characteristics of 12 cases of CWRR from Oct 2005 to Apr 2011 were reviewed, including preoperative treatment, surgical approach, resection range, reconstruction methods, the local and systematic complications and postoperative survival. Results All 12 of these patients underwent radical resection and bony chest wall resection, with resultant bony chest wall defects ranging from 25 cm2 to 700 cm2, soft tissue defects of 56 cm2 to 400 cm2. The bony chest wall was reconstructed using polypropylene mesh, and repair of the soft tissue was carried out using the shifting muscle flaps, myocutaneous flaps and omental flaps. There was only one significant complication in these 12 cases where 1 case suffered respiratory failure and needed mechanical ventilation but recovered one month later. All 12 patients have survived to the end point of follow up. Conclusion Only thoracic surgery and reconstructive surgery work together can complete the complex CWRR which according the tumor discipline. Thoracic surgeons as the leader and reconstructive surgeons as the subsidiary and be familiar with reconstruction materials of bony chest wall and appropriate choice of soft tissue coverage is the key to achieve radical surgery and to ensure long-term survival.
Reconstruction of the chest wall with VYPRO I -Mesh after extensive resection
Wagner, Roland,Horn, Silvio,Stein, Martina,Gnauk, Hans-Georg
Thoracic Surgical Science , 2004,
Abstract: We performed reconstruction of the chest wall i.e. sternum, anterior or lateral thoracic wall by implantation of VYPRO I -Mesh in two layer fashion-technique in 12 consecutive patients after extended resection of the thoracic wall because of tumour.Mean follow-up was 18.6 months. This included complete physical examination, lung function analysis, and radiological examination with x-ray and CT-scan.The aim of stabilisation could be achieved in all patients: secure coverage of thoracic viscera, reconstruction of the physiological function of the chest wall with good cosmetic result, and excellent incorporation of the alloplastic material.
Chest Wall Reconstruction with Precontoured Locking Plate Proof of Concept  [PDF]
Elmer Lodder, Maarten van der Elst
Journal of Cancer Therapy (JCT) , 2010, DOI: 10.4236/jct.2010.13021
Abstract: Complications after chest wall resection are common and are reported to occur in approximately 40% of patients. The most frequent complications are respiratory or wound complications. Restoring rib continuity after a resection is likely to prevent respiratory complications. However many patients remain painful after a reconstruction. This article describes a new technique using a titanium alloy precontoured locking plate and locking screws to reconstruct the chest wall after resection of the 7th rib on the left.
Titanium Rib Plate Technique for Huge Chest Wall Reconstruction  [PDF]
Yong Han Yoon
Surgical Science (SS) , 2011, DOI: 10.4236/ss.2011.26070
Abstract: Chest wall reconstruction after en-bloc tumor resection is very important to preserve functional mobility and to enhance the cosmetic effect. Because they are flexible and pliable, titanium plates are proposed to reconstruct the chest wall, even though such chest wall reconstruction has been performed in only a few cases worldwide. We present a case of a 49-year-old man with a chondrosarcoma arising from the left 1st rib, invading the manubrium, clavicle, 2nd and 3rd ribs, and the anterior segment of the left upper lobe. After wide resection, the chest wall was reconstructed using titanium rib plates and Marlex mesh- the Bovine pericardium sandwich type. The patient tolerated the pain well, and fourteen months after surgery, the chest wall was well preserved function mobility and improved pulmonary function test.
Necrotizing fasciitis involving the chest and abdominal wall caused by Raoultella planticola
Si-Hyun Kim, Kyoung Ho Roh, Young Kyung Yoon, Dong Oh Kang, Dong Woo Lee, Min Ja Kim, Jang Wook Sohn
BMC Infectious Diseases , 2012, DOI: 10.1186/1471-2334-12-59
Abstract: We describe the first case of necrotizing fasciitis involving the chest and abdominal wall caused by R. planticola. The identity of the organism was confirmed using 16S rRNA sequencing. The patient was successfully treated with the appropriate antibiotics combined with operative drainage and debridement.R. planticola had been described as environmental species, but should be suspected in extensive necrotizing fasciitis after minor trauma in mild to moderate immunocompromised patients.Raoultella planticola is a Gram-negative, aerobic, non-motile, encapsulated rod bacterium [1]. Because these organisms are closely related to Klebsiella species, they can be easily misidentified as Klebsiella pneumoniae or Klebsiella oxytoca [2,3]. R. planticola is found in water, soil, and fish and was also isolated from clinical specimens and the hospital environment. However, human infections caused by R. planticola have been extremely rare, and the clinical significance remains uncharacterized. We describe the first case of necrotizing fasciitis involving the chest and abdominal wall caused by R. planticola.A 66-year-old man presented to the emergency department of University Hospital in Seoul, South Korea, complaining of severe, constant pain and bruising over the right flank for the previous 2 weeks. He had fallen, striking his right flank on the edge of the metal wastebasket approximately 4 weeks prior to presentation. At that time, he had a light abrasion on the right flank, but he did not receive any special treatment. He had a history of cardiovascular disease and poorly controlled type 2 diabetes mellitus over the past 40 years.On admission, the patient's mental status was alert. His vital signs were stable except for his temperature, which was 37.7°C. Physical examination revealed intense pain on palpation, crepitus, swelling, and bruising over the right side of the abdominal wall, extending into the shoulder. No traces of the original wound remained. There were no other abn
Chest physiotherapy during immediate postoperative period among patients undergoing upper abdominal surgery: randomized clinical trial
Manzano, Roberta Munhoz;Carvalho, Celso Ricardo Fernandes de;Saraiva-Romanholo, Beatriz Mangueira;Vieira, Joaquim Edson;
Sao Paulo Medical Journal , 2008, DOI: 10.1590/S1516-31802008000500005
Abstract: context and objective: abdominal surgical procedures increase pulmonary complication risks. the aim of this study was to evaluate the effectiveness of chest physiotherapy during the immediate postoperative period among patients undergoing elective upper abdominal surgery. design and setting: this randomized clinical trial was performed in the post-anesthesia care unit of a public university hospital. methods: thirty-one adults were randomly assigned to control (n = 16) and chest physiotherapy (n = 15) groups. spirometry, pulse oximetry and anamneses were performed preoperatively and on the second postoperative day. a visual pain scale was applied on the second postoperative day, before and after chest physiotherapy. the chest physiotherapy group received treatment at the post-anesthesia care unit, while the controls did not. surgery duration, length of hospital stay and postoperative pulmonary complications were gathered from patients' medical records. results: the control and chest physiotherapy groups presented decreased spirometry values after surgery but without any difference between them (forced vital capacity from 83.5 ± 17.1% to 62.7 ± 16.9% and from 95.7 ± 18.9% to 79.0 ± 26.9%, respectively). in contrast, the chest physiotherapy group presented improved oxygen-hemoglobin saturation after chest physiotherapy during the immediate postoperative period (p < 0.03) that did not last until the second postoperative day. the medical record data were similar between groups. conclusions: chest physiotherapy during the immediate postoperative period following upper abdominal surgery was effective for improving oxygen-hemoglobin saturation without increased abdominal pain. breathing exercises could be adopted at post-anesthesia care units with benefits for patients.
Free Tensor Fascia Lata Flap and Synthetic Mesh Reconstruction for Full-Thickness Chest Wall Defect  [PDF]
Jumpei Ono,Akira Takeda,Minekatsu Akimoto,Akira Iyoda,Yoshio Matsui,Yukitoshi Satoh,Eiju Uchinuma
Case Reports in Medicine , 2013, DOI: 10.1155/2013/914716
Abstract: A large full-thickness chest wall defect over 10?cm in diameter requires skeletal reconstruction and soft tissue coverage. Use of various flaps for soft tissue coverage was previously reported, but en bloc resection in each case affects these flap pedicles and sizes. We present a case of a 74-year-old man with a soft tissue tumor involving the left lateral chest wall. We performed an en block resection and skeletal reconstruction using a mesh, free tensor fascia lata (TFL) flap for soft tissue coverage. This procedure could be performed in one position. A fixed fascia lata of the flap was also useful for tight reconstruction with the mesh. We suggest that free TFL and/or anterior lateral thigh flap is a useful technique to reconstruct anterior to posterior lateral chest wall defects. 1. Introduction For a chest wall reconstruction, it is necessary to do a skeletal and soft tissue reconstruction. Management of the pleural cavity is important to decrease the rate of postoperative complications and mortality [1]. The availability of prosthetic materials influences the surgeon’s choice, and complications are sometimes caused by those materials [2–4]. Using flaps to repair a full-thickness defect depends on the reconstruction portion and size of the chest wall defect. Full-thickness chest wall reconstruction may be performed with a myocutaneous flap such as the latissimus dorsi or rectus abdominis [5], but the pedicles of these flaps could be resected with the tumor in some cases. Here we report a full-thickness chest wall reconstruction by free tensor fascia lata (TFL) flap, using a fascia lata and mesh for skeletal support for a patient with malignant fibrous histiocytoma (MFH) involving the chest wall. 2. Case Report A 74-year-old, otherwise healthy, man presented with a rapidly enlarging mass in his left chest wall. On physical examination, a tumor of about 20 × 15?cm was detected (Figure 1(a)). Magnetic resonance imaging revealed a tumor mass with invasion of the latissimus dorsi and serratus anterior muscle but not the ribs (Figure 1(b)). Metastatic disease was ruled out on computed tomographic scans of the brain, chest, and abdomen. Figure 1: (a) Tumor of left lateral chest wall. (b) Preoperative magnetic resonance image of the tumor. En bloc tumor and chest wall resection was performed with the patient in the right lateral position under the single-lung ventilation. The latissimus dorsi and serratus anterior muscles, the 4th through the 8th ribs, as well as those intercostal muscles with 3?cm margins from the tumor were resected through the marginal
Use of biological meshes for abdominal wall reconstruction in highly contaminated fields
Andrea Cavallaro, Emanuele Lo Menzo, Maria Di Vita, Antonio Zanghì, Vincenzo Cavallaro, Pier Francesco Veroux, Alessandro Cappellani
World Journal of Gastroenterology , 2010,
Abstract: Abdominal wall defects and incisional hernias represent a challenging problem. In particular, when a synthetic mesh is applied to contaminated wounds, its removal is required in 50%-90% of cases. Biosynthetic meshes are the newest tool available to surgeons and they could have a role in ventral hernia repair in a potentially contaminated field. We describe the use of a sheet of bovine pericardium graft in the reconstruction of abdominal wall defect in two patients. Bovine pericardium graft was placed in the retrorectus space and secured to the anterior abdominal wall using polypropylene sutures in a tension-free manner. We experienced no evidence of recurrence at 4 and 5 years follow-up.
Reconstruction of complex thoraco-abdominal defects with extended anterolateral thigh flap  [cached]
Yadav Prabha,Ahmad Quazi,Shankhdhar Vinay,Nambi G
Indian Journal of Plastic Surgery , 2010,
Abstract: Background: The reconstruction of complex thoraco-abdominal defects following tumour ablative procedures has evolved over the years from the use of pedicle flaps to free flaps. The free extended anterolateral thigh flap is a good choice to cover large defects in one stage. Materials and Methods: From 2004 to 2009, five patients with complex defects of the thoracic and abdominal wall following tumour ablation were reconstructed in one stage and were studied. The commonest tumour was chondrosarcoma. The skeletal component was reconstructed with methylmethacrylate bone cement and polypropylene mesh and the soft tissue with free extended anterolateral thigh flap. The flaps were anastomosed with internal mammary vessels. The donor sites of the flaps were covered with split-skin graft. Result: All the flaps survived well. One flap required re-exploration for venous congestion and was successfully salvaged. Two flaps had post operative wound infection and were managed conservatively. All flap donor sites developed hyper-pigmentation, contour deformity and cobble stone appearance. Conclusion: Single-stage reconstruction of the complex defects of the thoraco-abdominal region is feasible with extended anterolateral thigh flap and can be adopted as the first procedure of choice.
Chest wall reconstruction using a combined musculocutaneous anterolateral-anteromedial thigh flap  [cached]
Tan Pearlie,Wong Chin-Ho,Koong Heng-Nung,Tan Bien-Keem
Indian Journal of Plastic Surgery , 2010,
Abstract: We present a massive 25 cm x 20 cm chest wall defect resulting from resection of recurrent cystosarcoma phyllodes of the breast along with six ribs exposing pleura. The chest wall was reconstructed with a Prolene mesh-methylmethacrylate cement sandwich while soft tissue reconstruction was carried out using a combined free anterolateral-anteromedial thigh musculocutaneous flap with two separate pedicles, anastomosed to the thoracodorsal and thoracoacromial vessels respectively. We explain our rationale for and the advantages of combining the musculocutaneous anterolateral thigh flap with the anteromedial-rectus femoris thigh flap.
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