A ‘Patchy’ Approach to Chest Wall Resection and Reconstruction for Malignancy

Abstract

Purpose: Chest wall resection for malignancy can result in a significant defect requiring reconstruction. We noticed at our institution that the use of 2 mm polytetrafluoroethylene (GORE-TEX) patches for chest wall reconstruction was associated with a high rate of postoperative seroma. Local innovation to resolve this problem is to use 4 mm punch biopsy and place perforations in the patch. This allows any accumulated fluid to drain into the pleural cavity to be reabsorbed. We aimed to determine the factors associated with successful reconstruction with the use of a fenestrated GORE-TEX patch and our rates of postoperative complications, in particular seromas. There is a paucity of literature reporting the rate of postoperative seroma with the use of GORE-TEX patches. Methodology: We conducted a retrospective single-institution review of all the patients who underwent chest wall resection and reconstruction using a fenestrated GORE-TEX patch over a 2.5 year period. Patient characteristics, co-morbidities, operative data, reconstructive methods and materials were recorded. Complications and outcomes were reviewed, as well as the management of these complications. Results: From January 2013 to July 2016, eleven patients underwent chest wall resection and reconstruction with a fenestrated GORE-TEX patch. A multidisciplinary approach was undertaken for all cases with input from orthopaedic surgery and plastic surgery where appropriate. There was no 30 day mortality. Mean follow-up time was 15 months. Conclusion: There were no cases of postoperative seroma with use of the fenestrated GORE-TEX patch.