Large Chest Wall Defects Research Articles

The application of three-dimensional custom-made prostheses in chest wall reconstruction after oncologic sternal resection.

As one of the cutting-edge advances in the field of reconstruction, three-dimensional (3D) printing technology has been constantly being attempted to assist in the reconstruction of complicated large chest wall defects. However, there is little literature assessing the treatment outcomes of 3D printed prostheses for chest wall reconstruction. This study aimed to analyze the surgical outcomes of 3D custom-made prostheses for the reconstruction of oncologic sternal defects and to share our experience in the surgical management of these rare and complex cases. We summarized the clinical features of the sternal tumor in our center, described the surgical techniques of the application of 3D customized prosthesis for chest wall reconstruction, and analyzed the perioperative characteristics, complications, overall survival (OS), and recurrence-free survival of patients. Thirty-twopatients with the sternal tumor who underwent chest wall resection were identified, among which 13 patients used 3D custom-made titanium implants and 13 patients used titanium mesh for sternal reconstruction. 22 cases were malignant, and chondrosarcoma is the most common type. The mean age was 46.9 years, and 53% (17/32) of the patients were male. The average size of tumor was 6.4 cm, and the mean defect area was 76.4 cm2. 97% (31/32) patients received R0 resection. Complications were observed in 29% (9/32) of patients, of which wound infection (22%, 7/32) was the most common. The OS of the patients was 72% at 5 years. We demonstrated that with careful preoperative assessment, 3D customized prostheses could be a viable alternative for complex sternal reconstruction.

Chest wall reconstruction in recurrent breast carcinoma – a case report

IntroductionComplex chest wall reconstruction after an oncological resection requires a multidisciplinary approach with the aim of curative resection.AimThe complexity of such reconstruction is challenged by prior reconstructions that limit the options for free tissue transfer and recipient vessels for microsurgical anastomoses.Case studyWe present a case of an immunocompromised patient with prior breast reconstruction for left breast carcinoma with a pedicled lattisimus dorsi flap who presents with a recurrence to the latissimus dorsi flap requiring a more extensive oncological resection.Results and discussionThis resulted in a large chest wall defect that is reconstructed with plating and an anterolateral thigh fasciocutaneous free flap for soft tissue coverage.ConclusionsThe radical resection allows for excellent overall survival and better quality of life.

Latissimus Dorsi Flap Revisited: Coverage of Large Chest Wall Defects Following Mastectomy for Locally Advanced Breast Carcinoma and Angiosarcoma.

The latissimus dorsi myocutaneous flap (LDMF) remains a significant tool in the armamentarium of the oncoplastic breast surgeon. Despite declining popularity for reconstruction, owing to the increasing use of implants and free flaps, it still has an important role in certain salvage situations and as a flap to cover large defects. We report our experience with the use of LDMF for immediate coverage of large mastectomy defects when options are limited. Retrospective series of prospectively collected patient records. Patient and tumour characteristics, length of stay, and post-operative and oncologic outcomes are reported. Patients with angiosarcoma were discussed at tertiary sarcoma centres as per national guidelines. Operations were carried out by oncoplastic breast surgeons. The case series was approved by the institutional information governance department in line with institutional requirements for patient data sharing. All patients provided written consent for photography. Descriptive statistics were used to report findings.Median (IQR) was used for continuous variables. Six women were included, with a median age of 62.5 years, from December 2019 to October 2022. Follow-up ranged from 15 to 49 months. Median tumour size was 72.5 (16.25) mm. Four patients had locally advanced breast carcinoma (LABC), and two had breast angiosarcoma. The donor site and chest wall defects were closed primarily in all cases. Median length of stay was three nights. All mastectomy wounds healed without issues and any delay to their adjuvant treatment. One patient had a minor latissimus dorsi (LD) donor site wound breakdown managed conservatively. Three patients had adjuvant radiotherapy after surgery. Four patients, one after high-grade angiosarcoma and three after aggressive breast carcinoma, had a locoregional recurrence or distant metastases and succumbed within 20 months of surgery. The LDMF can be a reliable option for the primary closure of large post-mastectomy wounds. Its use can lead to timely wound healing, allowing patients to undergo adjuvant treatment without delay. However, the overall oncologic outcomes in patients with LABC and angiosarcoma are poor due to the underlying aggressive tumour biology. Long-term outcomes are to be interpreted with caution due to the small number of patients with diverse pathologic features.

Functional biomimetic design of 3D printed polyether-ether-ketone flexible chest wall reconstruction implants for restoration of the respiration

The lack of deformability of rigid chest wall reconstruction (CWR) implants presents a challenge in reducing postoperative respiratory function in patients with large chest wall defects. Flexible poly-ether-ether-ketone (PEEK) CWR implants, consisting of rib components with elliptical cross-section and costal cartilage components featuring wavy structures, were developed with adjustable design parameters that allow quantitative restoration of respiratory function. During the design process, the equivalent elastic moduli of the rib and costal cartilage components were parametrically adjusted in a validated finite element (FE) model of the chest wall to maximise chest wall deformation during respiration, while considering mechanical safety as the boundary condition. The optimal equivalent elastic moduli were then translated into design parameters for the rib and costal cartilage components, based on a database relating the equivalent elastic modulus to the design parameters of the components with elliptical cross-section and wavy structures. The flexible PEEK CWR implant increased the difference in chest circumference during respiration by 12.2% compared to rigid PEEK implant in a clinical case-based study. This study presents a strategy to address the reduced respiratory function in 3D printed CWR implants, providing a pathway for quantitative restoration of respiratory function through parameterised optimisation.

Reconstruction of Anterior Chest Wall Defect Induced by Sterile Costochondritis: A Case Report of Non-radiographic Axial Spondyloarthritis

Non-radiographic axial spondyloarthritis (axSpA) is a subtype of axSpA characterized by chronic low back pain and stiffness but without radiographic evidence of sacroiliitis or spinal changes. As is the case with axSpA, early initiation of nonsteroidal anti-inflammatory drugs, tumor necrosis factor inhibitor agents, or physical therapy are often recommended for patients with non-radiographic axSpA. While the clinical course of non-radiographic axSpA is less well-known than axSpA, we present a case of a patient with non-radiographic axSpA manifesting as a sterile abscess in the sternum and costal cartilage. In this case report, we describe the diagnostic process for this rare manifestation and reconstruction of the large chest wall defect using a pedicled transverse rectus abdominis musculocutaneous flap.

The contribution of microvascular free flaps and pedicled flaps to successful chest wall surgery

ObjectivePedicled flaps (PFs) have historically served as the preferred option for reconstruction of large chest wall defects. More recently, the indications for microvascular-free flaps (MVFFs) have increased, particularly for defects in which PFs are inadequate or unavailable. We sought to compare oncologic and surgical outcomes between MVFFs and PFs in reconstructions of full-thickness chest wall defects. MethodsWe retrospectively identified all patients who underwent chest wall resection at our institution from 2000 to 2022. Patients were stratified by flap reconstruction. End points were defect size, rate of complete resection, rate of local recurrence, and postoperative outcomes. Multivariable analysis was performed to identify factors associated with complications at 30 days. ResultsIn total, 536 patients underwent chest wall resection, of whom 133 had flap reconstruction (MVFF, n = 28; PF, n = 105). The median (interquartile range) covered defect size was 172 cm2 (100-216 cm2) for patients receiving MVFF versus 109 cm2 (75-148 cm2) for patients receiving PF (P = .004). The rate of R0 resection was high in both groups (MVFF, 93% [n = 26]; PF, 86% [n = 90]; P = .5). The rate of local recurrence was 4% in MVFF patients (n = 1) versus 12% in PF patients (n = 13, P = .3). Postoperative complications were not statistically different between groups (odds ratio for PF, 1.37; 95% confidence interval, 0.39-5.14]; P = .6). Operative time >400 minutes was associated with 30-day complications (odds ratio, 3.22; 95% confidence interval, 1.10-9.93; P = .033). ConclusionsPatients with MVFFs had larger defects, a high rate of complete resection, and a low rate of local recurrence. MVFFs are a valid option for chest wall reconstructions.

Reverse Abdominoplasty for Mastectomy Defect Closure in Advanced Breast Cancer.

Breast cancer patients with locally advanced breast cancer who require radical mastectomy are left with large chest wall defects. This poses a significant reconstructive challenge as many high-risk patients require timely postmastectomy adjuvant therapy. While the reverse abdominoplasty technique is commonly used for aesthetic improvement of the anterior trunk, it can be also be effectively used for closure of extensive mastectomy defects in this patient population. We conducted a retrospective cohort study of all consecutive patients who underwent an extensive radical mastectomy followed by immediate closure with the reverse abdominoplasty technique at a single tertiary cancer center from June 2017 to July 2022. Patients who had concurrent skin grafting or breast mound flap reconstruction were excluded. Demographic, medical, oncologic, and reconstructive data were collected. Six patients were treated with reverse abdominoplasty for 9 chest wall defects after surgical excision of locally advanced breast cancer. The median tumor size was 10.7 cm (range, 6.7-10 cm) and the median mastectomy weight was 865.7 g (range, 356.4-1247.7 g). On average, the operation length was 191 minutes (range, 86-257 minutes) and the postoperative length of stay was 2.2 days (range, 1-5 days). All patients underwent systemic adjuvant therapy and the median time from surgery to initiation of therapy was 44.5 days (range, 32-75 days). Reverse abdominoplasty is a simple and safe technique to reliably close large defects after locally advanced breast cancer excision. It has a short operative time, hospital stay, and turnaround time to initiation of adjuvant therapy.

3D Printing Technology for Chest Wall Reconstruction With a Sternum-Ribs-Cartilage Titanium Implant: From Ideation to Creation.

We describe the use of 3-dimensional (3D) printing technology to plan and reconstruct the sternum, adjoining cartilages, and ribs with a custom-made, anatomically designed, 3D-printed titanium implant for an isolated sternal metastasis complicated with a pathological fracture. We imported submillimeter slice computed tomography scan data into Mimics Medical 20.0 software and by manual bone threshold segmentation created a 3D virtual model of the patient's chest wall and tumor. For all-around tumor-free margins, we grew the tumor by 2 cm. The replacement implant was designed in 3D using the anatomical features of the sternum, cartilages, and ribs and manufactured using TiMG 1 powder fusion technology. Physiotherapy was provided prior to and following surgery, and the impact of reconstruction on pulmonary functions was assessed. At surgery, the precise resection, clear margins, and a secure fit were achieved. At follow-up, there was no dislocation, paradoxical movement, change in performance status, or dyspnea. There was a decrease in forced expiratory volume in 1 s (FEV1) from 105% prior to surgery to 82% following surgery and in forced vital capacity (FVC) from 108% to 75%, with no difference in the FEV1/FVC ratio, suggesting a restrictive pattern of impairment. With 3D printing technology, reconstructing a large anterior chest wall defect with a custom-made, anatomical, 3D-printed titanium alloy implant is feasible and safe, and it preserves the shape, structure, and function of the chest wall, albeit with a restrictive pattern of pulmonary function, which can be addressed with physiotherapy.

T-INVERTED SHAPED RECTUS ABDOMINIS MYOCUTANEOUS (TI-RAM) FLAP FOR CHEST WALL RECONSTRUCTION

We present a case report of a 46-year-old man with a chest wall mass suspected for sarcoma who underwent wide surgical resection and reconstruction. The patient was treated with a large mass chest wall resection followed by a reconstruction using the myocutaneous rectus abdominis flap with a T-inverted shape skin paddle (Ti-RAM flap). This original flap design allowed us to cover a large chest wall defect due to a very extensive oncological resection while achieving an easier closure of the abdominal donor area.

Latissimus dorsi myocutaneous extended flap in the reconstruction of large chest wall defects after extensive resections in breast pathology

Latissimus dorsi myocutaneous extended flap in the reconstruction of large chest wall defects after extensive resections in breast pathology

Latissimus Dorsi Myocutaneous Extended Flap in the Reconstruction of Large Chest Wall Defects after Extensive Resections in Breast Pathology

Latissimus Dorsi Myocutaneous Extended Flap in the Reconstruction of Large Chest Wall Defects after Extensive Resections in Breast Pathology

The Defect Repair After a Giant Malignant Phyllodes Tumor Resection of Breast Using a Kiss Flap

Malignant phyllodes tumors of the breast are fairly rare and fast-growing tumors. They are not sensitive to chemotherapy or hormonal therapy. Therefore, the primary treatment for malignant phyllodes tumors is wide surgical excision. Herein, we report a case study which featured a 26-year-old woman presented with a giant malignant phyllodes tumor measuring 20 × 17 × 13 cm. In order to reduce the chance of local recurrence, treatment for these types of tumors usually involves extensive excision with at least 1 cm of surgical margins. The patient underwent mastectomy with negative surgical margins, which left a large skin defect of 25 × 15 cm. Repair of such a large skin defect is a challenge to breast surgeons. This is the first reported case in which a “kiss” flap was successfully used to repair the skin defect created after resection of a giant malignant phyllodes tumor. The kiss flap could be considered as an effective and simple method to repair large chest wall defects after resection of giant phyllodes tumors.

COMBINATION OF LICAP AND IMAP FLAP FOR TREATMENT OF LONG-LASTING CUTANEOUS FISTULAS OF THE CHEST WALL WITH OSTEOMYELITIS

Patients presenting large chest wall defects often represent a challenge, the more when other conditions, like osteomyelitis, may complicate the wound healing process. We present a case of long-lasting cutaneous fistulas of the chest wall caused by ribs and sternum osteomyelitis, refractory to both conservative and surgical treatment. Both lateral intercostal perforator flap and internal mammary perforator flap were performed in the same surgery for chest wall coverage after accurate debridement. The procedure allowed for resolution of osteomyelitis and wound healing with no recurrence. The purpose of this report is to highlight how, in apparently untreatable cutaneous fistulas caused by ribs and sternum osteomyelitis, an accurate debridement and coverage with perforators propeller flaps may be successful.

Chest Wall Reconstruction With 3D Printing: Anatomical and Functional Considerations.

Large chest wall defects, as a result of wide local excision of chest wall pathology, require skeletal and soft-tissue reconstruction to restore the anatomical shape, structure, and respiratory function of the thorax. Reconstruction is challenging and requires the surgical reconstructive team to understand the anatomic and physiologic morbidity related to the defect and the choice of reconstructive techniques available to restore form and function. Rapidly emerging 3-dimensional (3D) printing technology allows the reconstructive surgical team to customize the therapeutic process of skeletal reconstruction by accurately mimicking the shape and structure of the chest wall being replaced. An integrated knowledge of the anatomy, physiology, mechanics of breathing, and respiratory tests is important to restore form and function. The focus of this article is to review the anatomy, physiology, and assessment of respiratory function from the classical textbooks and integrate this knowledge with the precise anatomy of the chest wall created by 3D printing technology. By doing so, this article will demonstrate how 3D printing may help the reconstructive team to understand the anatomic and physiologic morbidity related to the chest wall defect and the importance of taking each of these aspects into consideration when undertaking chest wall reconstruction of the thorax.

Oncoplastic reconstruction of a large chest wall defect using dual fasciocutaneous flaps: A case report.

Introduction and importanceLarge chest wall defects in the context of breast cancer or its sequelae can be challenging to address. Oncoplastic techniques have been demonstrated to be safe and feasible options for immediate reconstruction. We describe the use of dual fasciocutaneous flaps for coverage following resection of a large chest wall mass in an area with a remote history of radiation therapy.Case presentationA 67-year-old woman with a distant history of bilateral mastectomies and adjuvant chemoradiation for Stage IIB triple negative invasive ductal carcinoma presented with an enlarging left chest wall mass and chronic wound. The mass was excised with adequate margins, and the resulting defect was reconstructed with two locoregional fasciocutaneous flaps. Pathology returned negative for malignancy and follow-up demonstrated viable flaps that were healing well.Clinical discussionFasciocutaneous flaps are one of many techniques for breast reconstruction and offer advantages of a relatively superficial dissection, shorter operative time, and decreased risk of functional impairment. They are consequently an attractive option for patients with multiple comorbidities and high risk of perioperative complications. Historically used for immediate reconstruction at the time of oncologic resection, we present its successful use decades after the index cancer operation to manage a chest wall defect secondary to radiation injury.ConclusionsOncoplastic reconstruction with dual fasciocutaneous flaps is a feasible option for a large chest wall defect in the setting of previous radiation.

Reverse Abdominoplasty: A Novel Practical Approach Using Oncoplastic Reconstruction in Managing Major Chest Wall Defects for Patients With Loco-Regional Recurrence Following Breast Cancer Surgery.

BackgroundLoco-regional recurrence of breast cancer in patients with large chest wall defects following mastectomy poses significant oncoplastic challenges. Reverse abdominoplasty is most commonly used to treat patients with excess upper abdominal soft tissue and laxity following massive weight loss. Widely employed as a technique for aesthetic contouring of the upper anterior trunk, as well as in augmentation mammoplasty, its use to date for reconstructive purposes is mainly limited to burns and large site surgical tumour ablation.MethodHere we review our experience of using reverse abdominoplasty as a novel approach to filling major anterior chest wall defects in patients with cutaneous manifestations of loco-regional or distant recurrence of breast cancer.ResultsSeven patients with metastatic breast cancer underwent reverse abdominoplasty for disease recurrence following mastectomy, with good patient-reported outcomes, and minimal surgical complications. Moreover, follow-up data in the patients surveyed also showed minimal to no limitations on their activities of daily living following the procedure.ConclusionHere we demonstrate the successful employment of reverse abdominoplasty - a technique not usually reserved in breast oncoplastic surgery - to treat fungating breast lesions and/or other manifestations of loco-regional recurrence in metastatic breast cancer. This may herald a paradigm shift in the way surgeons approach breast cancer recurrence in patients with pre-existing major chest wall defects.

P150 UTILISATION OF OVINE REINFORCED TISSUE MATRIX IN PAEDIATRIC RECONSTRUCTIVE SURGERY

Abstract Aim Abdominal and thoracic reconstructive surgery has always been an aspect of surgical care in children for conditions such as congenital abdominal wall defects, large hiatus herniae, incisional herniae and chest wall defects following tumour surgery. Biosynthetic matrices are ideal for reconstructive surgery in the paediatric population as consideration needs to be given to future growth and potential need for reoperation. Moreover, the use of synthetic materials in this setting is known to be associated with long term issues. We present the results of our experience with ovine reinforced tissue matrix1 in paediatric reconstructive surgery. Material and Methods All patients who underwent an operation at our institution using the biosynthetic matrix from March 2019 to April 2021 were identified retrospectively by searching theatre databases. Patient demographics, diagnoses and case notes were reviewed. Results The biosynthetic matrix was used in 26 children, (15 male and 11 female). Median age at insertion was 5.1 years (2.1 – 7.1 years). Median weight at insertion was 14.0kg (11.3 – 28.1kg). Patients had a history of hiatus hernia (n = 10), exomphalos (n = 6), emergency laparotomy (n = 3), congenital diaphragmatic hernia (n = 2) sternal sarcoma (n = 1), rib sarcoma (n = 1), gastroschisis (n = 1), recurrent umbilical hernia (n = 1) and direct inguinal hernia (n = 1). There were no hernial recurrences. There was a surgical site occurrence (SSO) in 12% - skin dehiscence (n = 2) and wound infection (n = 1). Median length of follow up was 7.9 months (4.5-9.0 months). Conclusions Our series demonstrates that ovine biosynthetic matrices can be used safely in paediatric reconstructive surgery with excellent outcomes and a very low rate of SSO. 1. OviTex®-TELA Bio

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.

Design, additive manufacture and clinical application of a patient-specific titanium implant to anatomically reconstruct a large chest wall defect

Purpose Chest wall reconstruction of large oncological defects following resection is challenging. Traditional management involves the use of different materials that surgeons creatively shape intraoperatively to restore the excised anatomy. This is time-consuming, difficult to mould into shape and causes some complications such as dislocation or paradoxical movement. This study aims to present the development and clinical implantation of a novel custom-made three-dimensional (3D) laser melting titanium alloy implant that reconstructs a large chest wall resection and maintains the integrity of the thoracic cage. Design/methodology/approach The whole development process of the novel implant is described: design specifications, computed tomography (CT) scan manipulation, 3D computer-assisted design (CAD), rapid prototyping, final manufacture and clinical implantation. A multidisciplinary collaboration in between engineers and surgeons guided the iterative design process. Findings The implant provided excellent aesthetical and functional results. The virtual planning and production of the implant prior to surgery reduced surgery time and uncertainty. It also improved safety and accuracy. The implant sited nicely on the patient anatomy after resection following the virtual plan. At six months following implantation, there were no implant-related complications of pain, infection, dislocation or paradoxical movement. This technique offered a fast lead-time for implant production, which is crucial for oncological treatment. Research limitations/implications More cases and a long-term follow-up are needed to confirm and quantify the benefits of this procedure; further research is also required to design a solution that better mimics the chest wall biomechanics while preventing implant complications. Originality/value The authors present a novel custom thoracic implant that provided a satisfactory reconstruction of a large chest wall defect, developed and implanted within three weeks to address a fast-growing chondrosarcoma. Furthermore, the authors describe its development process in detail as a design guideline, discussing potential improvements and critical design considerations so that this study can be replicated for future cases.

Chest wall reconstruction with a methyl-methacrylate sandwich after resection of large chest wall tumors: single center experience

Background: The advantages of methyl-methacrylate sandwich for chest wall reconstruction are controversial. We aimed to report the outcomes of chest wall reconstruction using a methyl-methacrylate sandwich after large tumor resection. Methods: This retrospective research included 30 patients who had chest wall reconstruction after resection of large tumors from January 2010 to December 2018 at a single center. All patients had skeletal reconstruction using a methyl-methacrylate sandwich with a Prolene mesh. Soft-tissue construction was performed with primary closure (n= 12), latissimus dorsi flap (n= 10), local flap (n= 4), and pectoralis muscle flap (n= 4).Results: Male presented 73.3% of the patients (n=22) and the median age was 50 years (range: 20- 75). The pathology of the resected tumors were infiltrating carcinoma of the lung (n= 6; 20%), undifferentiated pleomorphic sarcoma (n= 4; 13.3%), chondrosarcoma (n= 4; 13.3%), infiltrating adenocarcinoma of mesothelial origin (n= 4; 13.3%), adenocarcinoma of lung origin (n= 2; 6.7%), osteochondroma (n= 2; 6.7%), Ewing sarcoma (n= 2; 6.7%), round cell sarcoma (n= 2; 6.7%), sternal sarcoma (n= 2; 6.7%), and chondroma (n= 2; 6.7%). Postoperative complications occurred in 14 patients; atelectasis (n= 2; 13.3%), consolidation (n= 2; 6.7%), wound infection (n= 2; 6.7%), flap seroma (n= 2; 6.7%), acute respiratory distress syndrome (n= 2; 6.7%) and local recurrence (n= 2; 6.7%). We reported two late mortalities because of distant metastasis and sepsis Conclusion: Immediate reconstruction of large chest wall defects following tumor resection could be feasible using methyl-methacrylate filler with synthetic mesh with accepted morbidity and mortality.