Complex Chest Wall Reconstruction Research Articles

Complex chest wall reconstruction after failure: a literature review.

Primary and secondary chest wall tumors (bone, breast, and soft tissue), congenital defects, and chest wall osteoradionecrosis often require extensive full-thickness local excisions to guarantee safe oncological margins (in cases of tumors) and complex reconstruction to provide stabilization and good biomechanical results avoiding postoperative respiratory failure. Thus, a personalized approach is required when dealing with chest wall defects, and reconstruction is planned. This review summarizes failed chest wall reconstruction procedures, identifies causes of failure, and highlights principles for complex chest wall reconstruction post-failure. We performed a narrative review of the literature on PubMed, Scopus, ScienceDirect, and Google Scholar, including all the relevant studies published from 1970. The available experiences in literature are only anecdotic and no current guidelines or rules exist on this topic, also given to its rarity. Proper pre-surgical planning and a multidisciplinary team (MDT) discussion are crucial for complex cases such as infections and radiation-induced chest ulcers after previous surgical treatment. Procedures should eventually include thoracic wall debridement, necrotic tissue excision, pulse-jet lavage, prosthesis removal, and vacuum assisted closure (VAC) therapy as a bridge for chest wall re-reconstruction. Sternotomy wounds require wire and prosthesis removal, and the use of meshes or bone allografts. This review aims to summarize experiences and highlight surgical and oncologic principles for complex chest wall reconstruction after failure. This review summarizes literature experiences to identify common key points for chest wall reconstruction after failure and to give some advice to surgeons managing this rare, challenging surgery.

The role of 3D printing in chest wall reconstruction.

Technology is advancing fast, and chest wall surgery finds particular benefit in the broader availability of three-dimensional (3D) reconstruction and printing. An increasing number of reports are being published on the use of these resources in virtual 3D reconstructions of chest walls in computed tomography (CT) scans, virtual surgeries, 3D printing of real-size models for surgical planning, practice, and education, and of note, the manufacture of customized 3D printed implants, changing the fundamental conception from a surgery that fits all, to a surgery for each patient. In this review, we explore the evidence published on simple chest wall reconstruction, including the use of 3D technology to assist in the improvement of the repair of the most frequent chest wall deformities: pectus excavatum and carinatum. Current studies are oriented to the automatization and customization of transthoracic implants, as well as education on real-size models. Next, we investigate the implementation of 3D printing in the repair of complex chest wall reconstruction, comprised of infrequent chest wall deformities such as pectus arcuatum and Poland syndrome. These malformations are very heterogeneous resulting in a high degree of improvisation during the surgical repair. In this setting, 3D technology plays a role in the standardization of a process that contemplates customization, concepts that may seem contradictory. Finally, 3D printing with biocompatible materials is rapidly becoming the first choice for the reconstruction of wide chest wall oncological resections. In this work, we review the first and most important current publications on the subject.

Case Report of Complex Chest Wall Repair for Sternal Dehiscence After Bilateral Lung Transplantation

We report a case of a complex chest wall reconstruction because of sternal dehiscence, requiring different surgical procedures for its complete resolution. A 54-year-old man patient with Langerhans cell histiocytosis and chronic obstructive pulmonary disease underwent bilateral sequential lung transplantation through a clamshell incision, using nitinol thermo-reactive clips for sternal closure. One year later, he consulted because of chest pain, fever, and purulent secretions. Physical examination and chest X-ray revealed a right pulmonary hernia due to post-clamshell wound dehiscence. Chest wall repair was performed, placing an expanded-polytetrafluoroethylene synthetic mesh, and the sternum was realigned and fixated with titanium plates and screws. However, in the immediate postoperative period, there was a large amount of serous drainage through the surgical wound, needing negative pressure therapy. Unfortunately, the wound became necrotic with exposure to the osteosynthesis material. In addition, a chest computed tomography scan showed fluid accumulation in the anterior chest wall. Therefore, two-stage revision surgery was indicated: first, the removal of the previous prosthesis and, the definite one, the use of a pedicled latissimus dorsi myocutaneous flap to provide effective coverage of the wound. Sternal dehiscence is not an uncommon complication after clamshell incision in patients undergoing bilateral sequential lung transplantation, and it is associated with significant morbidity. In the presence of chest wall instability, surgical repair is mandatory.

Sternal Reconstruction Using 3D-Printed Titanium Custom-Made Prosthesis for Sternal Dehiscence After Cardiac Surgery.

Sternal dehiscence is an important complication that increases mortality and morbidity in cardiac surgery. Titanium plates have been used to reconstruct the chest wall for a long time. However, with the rise of 3D printing technology, a more sophisticated method, is making a breakthrough. Custom-made 3D-printed titanium prostheses are increasingly used in chest wall reconstruction because they allow almost perfect fitting to the patient's chest wall and lead to good functional and cosmetic results. This report presents a complex anterior chest wall reconstruction using a custom-made titanium 3D-printed implant in a patient with a sternal dehiscence after coronary artery bypass surgery. At first, reconstruction of the sternum was performed using conventional methods, which failed to give adequate results. Finally, a 3D-printed titanium custom-made prosthesis was used for the first time in our center. On the short- and mid-term follow up, good functional results were achieved. In conclusion, this method is suitable for sternal reconstruction after complications in the healing process of median sternotomy wounds in cardiac surgery, especially where other methods do not provide satisfactory results.

Challenges in Complex Oncological Chest Wall Reconstruction with Free Anterolateral Thigh Flap and Titanium Rib Plate.

Extensive chest wall tumor resection and reconstruction possess a formidable challenge and require good collaboration between thoracic and reconstructive surgeons. In this article, we reviewed our experience in six consecutive cases requiring complex chest wall resection and reconstruction with titanium rib plates and free anterolateral thigh fasciocutaneous flap with fascia lata with a minimum 24 months follow-up postoperatively. Six patients with a mean age of 54 were diagnosed to have locally advanced malignant ( n = 5) and benign ( n = 1) tumors. They underwent wide local excision with a mean of six ribs resected, and the average size of the soft tissue defect was 389cm 2 . The integrity of the thoracic cage was restored by using titanium rib plates. Fascia lata was harvested along with free anterolateral thigh fasciocutaneous flap to achieve near airtight closure of pleural space for soft tissue coverage. Two patients required early flap exploration with successful flap salvage. One flap failure was reported on postoperative day 11 due to a mechanical cause and a redo surgery was required. With an average stay of 3 days in the intensive care unit, no perioperative pulmonary complications were recorded. Complex oncological chest wall resection and reconstruction with titanium rib plates and free anterolateral thigh fasciocutaneous flap with fascia lata yielded satisfactory aesthetic and physiological functional outcomes.

Three-dimensional technologies in chest wall resection and reconstruction.

Resection and reconstruction of the chest wall can pose unique challenges given its vital role in the protection of the thoracic viscera and the dynamic part it plays in respiration. A number of new three-dimensional (3D) technologies may be invaluable in tackling these challenges. Herein we review the use of 3D technologies in preoperative imaging with virtual 3D models, printing of 3D models for preoperative planning, and printing of 3D prostheses when approaching complex chest wall reconstruction.

The Utility of the Omentum Flap for Complex Intrathoracic Problems.

Introduction: Omentum flap is a viable reconstructive option for complex chest wall and mediastinal reconstruction. The impact of vasoconstrictors and the laminar pattern of blood flow associated with left ventricular assist devices (LVADs) on the outcomes of reconstructions has not been thoroughly evaluated. Methods: A retrospective review of all patients who underwent chest wall or mediastinal reconstruction using pedicled omentum flaps between 2003 and 2019. Results: Forty patients (60% males) underwent chest wall or mediastinal reconstruction using a pedicled omentum flap at a mean age of 58 years. The median follow-up was 24.3 months. The most common indication was the reconstruction of anterior chest wall/sternal defects (n = 16), followed by coverage of repaired bronchopleural fistula (n = 6), osteoradionecrosis of the anterolateral chest wall (n = 5), reconstruction of anterior/lateral chest wall following oncologic resections (n = 5), coverage of replaced infected LVAD (n = 4), and coverage of exposed/replaced aortic root vascular grafts (n = 4). Vasoconstrictors were used in 26 patients (65%). Eight flaps had partial necrosis, and none of the flaps had complete necrosis. There was no difference in flap complication rates in patients who received vasoconstrictors during the case compared to those who did not (P = 1.0). Thirteen (33%) flaps were skin grafted at a median of 13 days with 100% skin graft viability. Abdominal incisional hernia developed in 8 patients. In patients with LVADs, the omentum remained viable during the follow-up period. Conclusion: The ability of the omentum to easily reach various regions in the chest and the low failure rate make this flap a reliable reconstructive method.

Complex anterior chest wall reconstruction after extensive oncologic resections: a narrative review.

Objective:This report serves to showcase four cases of rare, malignant primary neoplasms of the anterior chest wall [chondrosarcoma and basal cell carcinoma (BCC)] that thoracic surgeons may encounter, and different approaches to complex reconstruction that may be necessary following resection.Background:Approximately 60% of the anterior chest wall neoplasms are malignant. The most common types of primary sternal tumors are chondrosarcoma and osteosarcoma. While guidelines for resection of these tumors have been previously described in the literature, guidelines regarding reconstructive techniques of the subsequent large defects are infrequently demonstrated.Methods:The medical records of four adult patients with primary chest wall tumors who underwent resection of the sternum from October 2016 to March 2021 were retrospectively reviewed. Radical resection with tumor-free surgical margins offers the best chance for survival, but results in a wide full-thickness defect. Hence, closure of the anterior chest wall defect with skeletal reconstruction is an essential step of the procedure and allows us to highlight surgical techniques and materials that have been used over recent years. Methods described herein include skeletal reconstruction with various hardware or allograft, as well as defect coverage using regional flaps, free tissue transfer, and mesh.Conclusions:Primary chest wall tumors of the sternum are an extremely rare diagnosis with a high malignancy rate. Full-thickness radical en-bloc resection is the most effective treatment option. Subsequent reconstruction of a wide chest wall defect is the most challenging aspect, though crucial in the preservation of the rigidity of the chest wall and protection of underlying structures. Different techniques and materials have been described without clear guidelines in treatment approaches; this paper serves to delineate and describe techniques that achieved successful outcomes.

Bilateral Anterolateral Thigh Myocutaneous Flaps for Giant Complex Chest Wall Reconstruction.

Extensive reconstruction of complex full-thickness chest wall oncological defects is challenging. Bilateral free anterolateral thigh (ALT) myocutaneous flap transfer for the complex reconstruction of a large area of the chest wall is discussed. We reported a single unit's experience in 1-staged multilayered reconstruction of large full-thickness chest wall defects in 22 patients (16 primary chest wall tumor cases, 5 locally advanced breast cancer cases, and 1 osteoradionecrosis case) treated between 2011 and 2018. Bilateral ALT myocutaneous flaps together with traditional cement implant or unmovable/movable joint conformable titanium struts were used for chest wall reconstruction. The anatomical characteristics of pedicle origin and pattern of the venae comitantes of the ALT myocutaneous flap, recipient vessels, and anastomosis patterns were described. Bilateral ALT myocutaneous flaps were used for soft tissue reconstruction in 22 cases. Different methods of flap harvesting and vascular anastomosis were selected as needed. No vein grafts or arteriovenous loops were required. We observed 3 vascular patterns of the flap pedicle, including 1 oblique branch and descending branch (59.1%, n = 26), 2 single descending branch (9.1%, n = 4), and 3 double branches of the descending branch (31.8%, n = 14). The flap was harvested pedicled with solely the oblique branch in 7 (15.9%) cases, solely the descending branch in 28 (63.6%) cases to minimize the donor site morbidity, and pedicled with the oblique and descending branch in 9 (20.5%) cases to achieve multiple vascular anastomosis choices. Stable skeletal reconstructions were achieved using traditional cement implant (13.6%, n = 3) or conformable titanium struts (86.4%, n = 19), with good fixation strength. Complication risk was low. An algorithmic approach to management is presented and recommended. Various forms of bilateral ALT myocutaneous flap transfer with different skeletal reconstruction presents as a reliable treatment for patients with large full-thickness chest wall defects. Anatomical variations in the pedicle and pattern of venae comitantes of the ALT myocutaneous flap are reported. In some challenging cases, finding the vessels in the recipient area is difficult. The clinical significance of each vascular pattern is delineated, and surgical technical considerations are discussed on the basis of the recipient area requirements and types of a flap's vascular anatomy.

Principles of complex chest wall reconstruction

Principles of complex chest wall reconstruction

A new technique in complex chest wall reconstruction: Open reduction and internal fixation

BackgroundReconstruction of complex chest wall deformities is a surgical challenge. A new technique can improve long-term outcomes and result in high patient satisfaction. MethodsA multicenter study was conducted on pediatric patients undergoing complex chest wall reconstruction between September 2015 and January 2018. The evolution of the technique using open reduction and internal fixation (ORIF) with SternaLock® and RibFix® to repair chest wall deformities is described. ResultsSeventeen patients underwent complex chest wall reconstruction with ORIF. Eight patients had severe or recurrent pectus excavatum, five patients had pectus carinatum, and four patients had complex chest wall fractures or other anomalies causing significant chronic pain. Up to three SternaLock® plates and four RibFix® plates were used for each procedure. Median length of hospital stay after surgery was four days. Median follow-up time was 12 months (range 2–30). There were no postsurgical complications. There was 100% patient satisfaction in postoperative recovery and cosmesis. ConclusionORIF using SternaLock® and RibFix® is an effective method of reconstructing complex chest wall deformities. This technique improves physical stability without the requirement of a subsequent surgery and enhances overall patient satisfaction. High volume centers should integrate this novel approach for challenging chest wall reconstruction. Type of studyTreatment study: case series. Level of evidenceLevel IV.

Abstract 64: Synthetic Mesh versus Acellular Dermal Matrix for Oncologic Chest Wall Reconstruction: A Comparative Analysis

PURPOSE: Management of chest wall reconstruction (CWR) following oncologic resection is challenging due to the nature if pathology, the radical procedure, and the employment of prosthetic materials required for biomechanical stability. Traditional material for CWR includes synthetic prosthesis (i.e. polypropylene or polytetrafluorethylene). However, biologic meshes might result in less wound complications. The aim of this study was to determine whether acellular dermal matrix (ADM) is associated with a lower incidence of complications following chest wall reconstruction for an oncologic resection defect compared to synthetic mesh. METHODS: We performed a retrospective study of consecutive patients who underwent complex chest wall reconstruction (CWR) using synthetic mesh (SM) or ADM at a single center. Only defects involving at least one rib resection and reconstructed with both mesh and flaps were included. We therefore excluded flap only or mesh only reconstructions and patients with a follow-up <6 months. Patients’ characteristics, treatment factors and outcomes were prospectively documented. The primary outcome measure for the SM versus ADM groups was surgical site occurrence (SSO). Secondary outcomes were specific wound healing, infective, and medical complications, as well as 90-day mortality and re-operation. RESULTS: One hundred forty six patients (95 [65.1%] with SM; 51 [34.9%] with ADM) underwent CWR with both mesh and flaps for repair of oncologic resection defect. Mean follow-up was 29.3 months (range, 6–109), mean age was 51.5 years, and mean defect area was 173.8 cm2. SM CWR patients underwent more rib resections (2.7 vs 2.0 ribs, P = 0.006) but similar sternal resections (29.5% vs 23.5%; P = 0.591) than ADM CWR patients. SM CWR patients experienced a significantly higher SSO (32.6% vs 15.7%, P = 0.027) than ADM CWR patients. The 2 groups had similar rates of specific wound healing complications. No differences in 90-day mortality, nor re-operations were observed. Multivariable analysis identified prolonged hospital stay, comorbidity, prolonged operative time, and synthetic repairs to be predictive factors of SSO. CONCLUSION: ADM CWR results in less SSO than SM CWR, when combined with soft tissue flap coverage. Surgeons should consider selectively employing ADM for CWR in patients at higher wound healing risk of complications.

Biosynthetic Nanostructured Cellulose Patch for Chest Wall Reconstruction: Five-Month Follow-up in a Porcine Model

ABSTRACTPurpose: Ideal approaches and materials for reconstruction of large chest wall defects remain a topic of debate. We sought to explore the suitability of a reinforced nanostructured cellulose (NC) patch for chest wall reconstruction in an animal model. Materials and Methods: In four domestic pigs, a standardized 10 × 10 cm chest wall defect was created by resecting three rib segments. Subsequently the defect was reconstructed via a biosynthetic NC patch (16 × 12 cm) reinforced by polytetrafluoroethylene mesh. After 1, 2, 4, and 5 months respectively, gross examination of NC patches was performed following sacrifice of the animals. Specimens of NC patches and surrounding connective tissue underwent histological examinations after staining with Hematoxylin-eosin and Elastica van Gieson. Results: All animals survived their observation period without encountering major adverse events. On gross examination all NC patches were intact and well integrated into the surrounding tissue. Histological examination showed clearly demarked zones of foreign body reaction at the patch/host-tissue interface. After 5 months a slight increase in foreign body reaction, fibrous capsule formation and cellular infiltration were observed. No signs of fibroblast proliferation or neovascularization were seen within NC patches at any point. Conclusions: Our findings suggest a quick healing process and good overall biocompatibility following NC patch implantation.NC might prove an efficient and suitable biomaterial for complex chest wall reconstruction.

Experience with Porcine Acellular Dermal Collagen Mesh (Permacol&amp;amp;trade; Surgical Implant) in Chest Wall Reconstruction after Resection for Rib Osteomyelitis

Chest wall reconstruction after rib resection is essential to ensuring chest wall stability, avoiding flail chest and pulmonary hernia, and improving pulmonary function. Traditionally, a synthetic mesh and a musculocutaneous flap have been used to bridge the chest wall defect. However, a risk of secondary prosthesis infection exists. Acellular dermal collagen mesh implants (Permacol™) are indicated for the reconstruction and reformation of human soft connective tissue. A case of a complex chest wall reconstruction after rib resection for osteomyelitis due to staphylococcus aureus infection in a malnourished, immunosuppressed, and methadone-addicted patient is presented. The patient underwent a left posterolateral thoracotomy and chest wall resection, involving three ribs and the soft tissues overlying an infected cutaneous fistula. The chest wall was reconstructed using a 28 × 18 cm piece of porcine sterile acellular dermal collagen mesh. A successful chest wall repair was achieved with no incisional herniation and with complete mesh incorporation, allowing physiologic respiratory movements. A typical wound seroma developed and resorbed over the following months. There was no infection. In conclusion, this case report suggests that Permacol™ surgical implant can be used successfully as an alternative to synthetic mesh in reconstruction of an infected chest wall.

Postoperative Local Morbidity and the Use of Vacuum-Assisted Closure After Complex Chest Wall Reconstructions With New and Conventional Materials

New materials (NM) such as titanium plates, cryopreserved grafts, and acellular collagen matrices are being increasingly used for chest wall reconstruction as a result of improved incorporation while maintaining structural stability and reduced need for removal from infected areas. Direct comparisons between NM and conventional materials (CM) in terms of local morbidity and need for prosthesis removal are lacking. Between January 2005 and July 2013, 109 procedures were performed to remove chest wall tumors in 86 patients. Of these, 32 underwent complex chest wall reconstructions owing to either recurrence, defect extension (greater than 3 ribs or >100 cm2) or local conditions (ie, previous irradiation or infection). New materials and CM (ie, polytetrafluoroethylene and methyl methacrylate) were used in 17 (53%) and 15 (47%) patients, respectively. Of the 32 patients included in the high complexity group, 23 patients did not exhibit any postoperative complications (72%). However, 9 patients (28%) underwent both a first and a second reoperation after a median interval of 4 months from the first procedure (range, 7 days to 60 months). Vacuum-assisted closure (VAC) was instituted in all patients as a means to control sepsis and facilitate space obliteration with healthy tissue. In 7 patients the reason for reintervention was local wound complications. In 4 of 7 patients, the prosthesis had to be removed (3 CM and 1 NM, 4.6% of the whole series; 12.5% in the high complexity group, 5.9% for NM and 20% for CM). The median time to complete chest wall healing after VAC in patients with local sepsis was 14 months (range, 5 to 60 months). All patients are currently alive and well except for 1 who died 11 months after complete chest wall healing as a result of dissemination of metastatic chondrosarcoma. At univariate analysis, predictors of overall and grade 2 or less morbidity according to the Common Terminology Criteria for Adverse Events version 4.0 were first (p=0.038) and second (p=0.015) redo operations. Conversely, patients with a body mass index of less than 25 kg/m2 (p=0.049) undergoing one (p=0.032) or two reconstructions (p=0.00047) with combined materials (p=0.00029) were more likely to experience local wound complications and require VAC. On multiple regression analysis, redo operations (first, p=0.032; second, p=0.00047) and the use of combined (synthetic and biologic) materials (p=0.0029) were confirmed to be related to an increased incidence of wound complications. Multiple redo operations after complex chest wall reconstruction performed with a combination of NM and CM may be associated with an increased incidence of local wound complications. Nevertheless, in these cases, the use of NM and VAC yielded a low rate (5.8% versus 20% with CM) of prosthesis removal while achieving complete wound healing.

Surgically-challenging chondrosarcomas of the chest wall: five-year follow-up at a single institution

Surgically-challenging chondrosarcomas of the chest wall: five-year follow-up at a single institution

Anterolateral Thigh Free Flap for Complex Composite Central Chest Wall Defect Reconstruction with Extrathoracic Microvascular Anastomoses

Complex central chest wall resection defects present a challenging management problem for both thoracic and reconstructive surgeons. Although most chest wall defects can be repaired using local and regional flaps, more complicated cases require increasingly sophisticated techniques such as microsurgical free tissue transfer. This study reviews a single plastic surgeon's experience over a 4-year period with complex chest wall reconstruction using the anterolateral thigh free flap. Five female patients who underwent the above procedure between 2004 and 2007 were reviewed retrospectively. The clinicopathologic details recorded included histologic diagnosis, extent of resection, type of skeletal defect, flap size, receipt vessels, ischemia time, and flap/donor-site complications. Skeletal reconstruction used methylmethacrylate/polypropylene mesh sandwich prostheses. The indications for surgery were metastatic breast cancer (n=3), advanced primary fibrosarcoma (n=1), and extensive radionecrosis (n=1). The average surface area of the chest wall resection was 197 cm (range, 156 to 270 cm). The four patients who underwent partial sternectomy and rib resection required skeletal reconstruction and subsequent ventilatory support postoperatively in the intensive care unit. The mean anterolateral thigh flap size was 188 cm (range, 143 to 252 cm); none of the donor sites was skin grafted. There was 100 percent flap survival, and the prostheses remained fully covered in all cases after a mean follow-up of 16 months (range, 5 to 28 months). No major complications were observed. The anterolateral thigh free flap is a safe and reliable option for reconstructing complicated composite chest wall defects. It therefore provides a practical alternative when regional pedicled flap options are unavailable or inadequate.

The use of Permacol ® for chest wall reconstruction in a case of desmoid tumour resection

Desmoid tumour resection is a known, albeit rare, cause for chest wall reconstruction. Traditionally, musculocutaneous flaps and synthetic mesh materials have been employed for coverage over these potentially large thoracic defects. More recently, biologic mesh materials have become increasingly more prevalent in a multitude of surgical reconstructions. To date, the current literature describes the usage of select biologic materials, such as human cadaveric acellular dermal matrix, in chest wall reconstruction. One variation of the biologic materials, Permacol(®), has not been well described in the literature for chest wall reconstruction. Permacol(®) is a porcine lyophilised acellular dermal collagen. We report the successful use of Permacol(®) in a complex chest wall reconstruction following the resection of a large desmoid tumour.

A free fibula autologous transfer for a full-thickness anterior chest wall defect

Large defects of the anterior chest wall lead to gross chest instability which can result in paradoxical respiration. Skeletal stabilization is an essential requirement in such cases. The current methods for achieving total or near total sternal reconstructions involve the use of alloplastic implant materials: prosthetic mesh with methyl methacrylate. In our experience, this method of reconstruction is often complicated by a persistent seroma and infection. A large full-thickness sternal defect was reconstructed by an osteotomized free fibula "Z" transfer and bilateral bipedicled pectoralis major myocutaneous flaps. This case highlights the use of vascularized autologous tissue for a complex full-thickness anterior chest wall reconstruction.

Malignant chest wall tumors in children and young adults

Purpose: Primary chest wall malignancies, which occur infrequently in children, can pose complex technical challenges to the surgeon. This study was undertaken to evaluate the pathology, treatment approaches, role of surgical resection and reconstruction, and outcomes of patients with these tumors. Methods: This is a retrospective review of all patients with malignant primary chest wall tumors treated at our institution between February 1983 and July 1998. Results: Nineteen cases were identified: malignant small round cell type (MSRCT, also called Ewing's sarcoma, primitive neuroectodermal tumor [PNET], and Askin's tumor; n = 8), rhabdomyosarcoma (RMS; n = 6), and other tumors (n = 5). Three patients underwent “upfront” complete resections. Sixteen patients underwent initial biopsy, followed by chemo-or radiotherapy. Nine of these 16 survived to undergo delayed chest wall resections. Six of the 12 “resected” patients required en bloc resection of adjacent muscles or organs; 7 required complex chest wall reconstruction. Eight of 19 patients (42%) have survived (median follow-up of survivors, 4 years), all with no evidence of disease; the remaining 11 patients died of progressive disease. Local invasion did not alter chance of survival. Two of the 10 patients with metastases at diagnosis (20%) survived. Six of the 9 patients (67%) with localized disease survived. All five patients with tumor types other than MSRCT or RMS, metastatic or not at diagnosis, are alive with no evidence of disease. There were no local recurrences. Conclusion: Surgical resection, with en bloc removal of involved structures and chest wall reconstruction, provides excellent local control of malignant chest wall tumors.