Different Prosthetic Treatment Modalities for Chest Wall Reconstruction: Experience With 96 Patients

Abstract

We report the outcomes of patients who underwent reconstruction with Mersilene mesh–methyl methacrylate (MM–MM) sandwich and polytetrafluoroethylene (PTFE) grafts after a large chest wall resection. Between June 1990 and July 2017, 96 consecutive patients (57 men, 39 women; mean age 45.6 years [range 5–74]) underwent large chest wall resection (>5 cm diameter) and reconstruction with prosthetic material. In total, 21 patients (22%) underwent reconstruction with a PTFE graft (group 2) between 1990 and 1994, and 64 patients (67%) underwent reconstruction with an sandwich graft (group 1) between 1994 and 2017. A titanium rib was used in 11 (11%) patients (group 3). Operative morbidity ratios were 2.5% (n = 2/64) in group 1 and 24% (n = 5/21) in group 2 (P = .02). The paradoxical respiration ratio was significantly higher (P = .01) in group 2 (n = 5/21 [24%]) compared with group 1 (n = 1/64 [1.6%]). The operative mortality ratio was 4.5% (n = 1/21) in group 2 and 0% in group 1. Mean length of hospital stay was 7.3 days (range 4-21) in group 1 and 13.3 days (range 7-36) in group 2 (P = .011). The Sandwich graft is inexpensive and easy to apply, provides better cosmetic options, and offers minimal morbidity. We therefore recommend that the sandwich graft be used rather than the PTFE graft for large defects of the anterolateral chest wall and sternum where successful prevention of paradoxical respiration is required.