Chestwall resection: a new and simple method for stabilization of extended defects

Abstract

Postresectional chestwall defects can usually be stabilized by reconstructions under tension. Only few extended defects require combined stabilizing methods. The one used mostly is Marlex-Sandwich, despite some disadvantages. An alternative method using alloplastic material/metal bar is presented. Between 1986 and 1999, 189 chestwall resections were performed either for infiltrating bronchogenic carcinoma (Type I, n=67), tumors originating from chestwall or bony metastases (Type II, n=88), or local recurrences and infiltration by breast cancer or sequelae of its treatment (Type III, n=34). The standard reconstruction is performed with non-absorbable alloplastic meshes or patches under some degree of tension. For defects exceeding 250 cm(2), usually Type-II cases, a reconstruction under tension is no longer appropriate. Therefore we developed a procedure which we used in six cases. Alloplastic mesh or patch gets sutured in the same way as is done in smaller defects. Then a metal bar (Grob-Stab, Ulrich, Herrlingen/Blaustein, Germany) is threaded through the alloplastic material and is fixed at the adjacent ribs by Parham steel bands (Ethicon, Sommerville, KY, USA). In all cases we achieved excellent stability. All of the patients were extubated on the operating table. There was no morbidity or mortality. In three cases the metal bars were removed after 3, 6 and 16 months postoperatively (dynamization). The new procedure is safe, simple and quickly performed. The additional costs are low (160 euro). The patient's comfort is excellent; borderline problems as described for Marlex-Sandwich can be avoided, so that this procedure can be considered as an alternative to Marlex-Sandwich.