Abstract
IntroductionRegardless of its rarity, and indolent clinical course, chest wall tumor places high morbidity and burden on patients especially when invasion to a neighboring structure is found. Once detected, surgery is the cornerstone for treatment of such etiology combined with chemo-radiotherapy. In order to maintain intact respiratory function, chest wall reconstruction must be performed whenever resection is done. Herein, we present a case of chest wall tumor that necessitated three ribs and part of hemidiaphragm resection and reconstruction with optimal post-operative results.Case presentationA 27-year-old male patient who had chest wall and diaphragm reconstruction for a chest wall Ewing sarcoma, using a single patch of expanded polytetrafluoroethylene (ePTFE) mesh with diaphragm implanted into the middle of the mesh. There were no immediate nor post-operative complications. The patient received post-operative radiotherapy with good functional and cosmetic results.ConclusionWe present a novel and safe technique for combined chest wall and diaphragmatic resection following excision of an invading tumor while ensuring cosmesis and functionality of the ribcage as well as the diaphragm.
Highlights
Regardless of its rarity, and indolent clinical course, chest wall tumor places high morbidity and burden on patients especially when invasion to a neighboring structure is found
Case presentation: A 27-year-old male patient who had chest wall and diaphragm reconstruction for a chest wall Ewing sarcoma, using a single patch of expanded polytetrafluoroethylene mesh with diaphragm implanted into the middle of the mesh
Once suspected, computed tomography (CT) scan and magnetic resonance imaging (MRI) studies must be carried out for better understanding of the tumor’s etiology, followed by an adequate biopsy, all of which must be guided via a multidisciplinary approach for treatment planning [1, 4, 5]
Summary
A variety of reconstruction methods have been proposed and attempted for chest wall reconstruction. If diaphragm resection was done, either separate synthetic materials were used to cover each defect separately or a custom-made mesh was utilized for combined reconstruction. We describe a method for reconstructing the chest wall and diaphragm using a single patch of ePTFE without sacrificing functionality of either. Even though the technique proposed is simple, meticulous care must be given to ensure suturing of the diaphragm into the correct position to avoid flattening of its dome shaped surface and rigorous attention should be given to secure air-seal and water-seal to the chest wall in order to preserve the natural breathing mechanism of this cavity
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