Technique For Chest Wall Reconstruction Research Articles

An Improved Chest Wall Reconstruction Technique With Twisted Steel Wire–Reinforced Neoribs

PurposeLarge chest wall defects often require reconstruction to improve the functionality of the chest wall and to achieve aesthetic results. An optimized technique for chest wall reconstruction with superior mechanical properties is presented here. DescriptionIn this technique, the chest wall is reconstructed by neoribs. Synthetic neoribs are constructed by integration of twisted steel wires with bone cement, customized for the patient and without the exposure of cement to the medullary cavity of the ribs. EvaluationThe proposed technique is easy to reproduce, is low cost, and achieves excellent aesthetic results. Compared with other techniques, this technique achieves superior tensile and compressive strengths. ConclusionsReconstruction of the chest wall with neoribs reinforced with twisted steel wire seems to be the optimal technique for chest wall reconstruction, with improved mechanical properties.

BIOMECHANICAL AND PHYSIOLOGICAL PRINCIPLES APPLIED IN CHEST WALL RECONSTRUCTION ASSOCIATED WITH RIB FRACTURES

TYPE: Abstract TOPIC: Cardiothoracic Surgery PURPOSE: The aim of this study was to describe osseointegration of osteosynthesis material and risk of surgical intervention when biomechanical and physiological principles are applied in chest wall reconstruction (CWR). METHODS: All adult patients with pulmonary contusion, multiple rib fractures, flail chest, hemothorax or pneumothorax associated with rib fractures who underwent CWR between March 2012 and December 2016 in emergency department retrospectively included.Titanium clips pressure-fitted at 2 cm proximal and distal were used at each fracture site. Curvature of the clip was made to simulate the natural curvature of the costal arch. In all cases the vascular and nervous package was released. Postoperative follow-ups were obtained from medical records and the integration of the osteosynthesis material was assessed. RESULTS: The 60 patients were 37 men and 23 woman, average age of 44 years. Hospital stays between 7 and 16 days. At 30 days postoperative complications had been recorded such as respiratory insufficiency (n=2) and acute myocardial infarction (n=1).Osteointegration of the osteosynthesis material was found in 59 patients (98.3%) and 1 patient (1.6%) present refracture and mobilization of a titanium implant, for which it was surgery reintervened and the defect corrected CONCLUSIONS: In our study, we found a very high percentage of osseointegration when using the biomechanical principles in the techniques for CWR. CLINICAL IMPLICATIONS: The healing process near fracture sites relies in a correct immobilization,adequate vascularization and formation of bone callus and new bone therefore, by using titanium clips combined with different biomechanical principles they help this purpose by improving the conditions at the fracture site. DISCLOSURE: Nothing to declare. KEYWORD: CHEST WALL RECONSTRUCTION

Acellular dermal matrix and bone cement sandwich technique for chest wall reconstruction.

The authors performed rigid reconstruction using the sandwich technique for full-thickness chest wall defects by using two layers of acellular dermal matrix and bone cement. We assessed six patients who underwent chest wall reconstruction. Reconstruction was performed by sandwiching bone cement between two layers of acellular dermal matrix. In all patients, there was no defect of the overlying soft tissue, and primary closure was performed for external wounds. The average follow-up period was 4 years (range, 2–8 years). No major complications were noted. The sandwich technique can serve as an efficient and safe option for chest wall reconstruction.

Chest wall—reconstruction: yesterday, today and the future

Chest wall reconstruction is crucial not only for an uneventful postoperative period after chest wall resection, but also, for ensuring a lifelong good quality of life for the patient. Complex reconstructions should be carefully planned and, sometimes, plastic surgeons are essential for a successful procedure. Various materials and surgical strategies have been developed, giving us the opportunity to choose the best technique for our patient. Emerging developments are mostly based on the use of new materials and the possibility of 3D custom made prosthesis. Currently, this approach is expensive making it exclusive, but in the short term, probably, it will be open for most thoracic units. Nevertheless, we cannot forget that standard surgical procedures, although not so fancy, have demonstrated to be effective and these techniques are universally available. This paper reviews techniques for chest wall reconstruction of large defects from traditional up to the most recently developed techniques.

Modified Nipple Flap with Free Areolar Graft for Component Nipple-Areola Complex Construction: Outcomes with a Novel Technique for Chest Wall Reconstruction in Transgender Men.

A primary goal in chest wall reconstruction ("top surgery") for trans men is achieving a symmetric, aesthetically pleasing position of the reconstructed male nipple-areola complex. The senior author's (A.H.) technique for component nipple-areola complex creation in chest wall reconstruction for trans men with a modified skate flap and free areolar graft, in conjunction with double-incision mastectomy, is described. A retrospective analysis of 50 consecutive patients who underwent primary, bilateral chest wall reconstruction with this technique was undertaken for the period of March of 2015 to October of 2016. The average patient age was 30.64 years, and the average body mass index was 28.54 kg/m. Eighty-two percent of the sample received preoperative testosterone therapy, and average operative time was 2 hours 59 minutes. Average overall mastectomy specimen weight was 627.80 g, average length of hospital stay was 0.96 days, and average follow-up duration was 19.02 months. Complications occurred in five patients (10 percent), including seroma (4 percent), cellulitis (2 percent), hematoma (2 percent), and suture granuloma (2 percent). Only five patients (10 percent) underwent postoperative revision to adjust nipple-areola complex size, projection, or symmetry. Twenty-eight patients (56 percent) underwent secondary revisions, including scar revisions (56 percent), liposuction (12 percent), and fat grafting (2 percent). The use of a modified nipple flap and free areola graft in transgender chest wall reconstruction for trans men allows for flexible, component construction of the male nipple-areola complex in a safe and effective manner. Therapeutic, IV.

Materials and techniques in chest wall reconstruction: a review.

Extensive chest wall resection and reconstruction are a challenging procedure that requires a multidisciplinary approach, including input from thoracic surgeon, plastic surgeon and oncologist. In particular chest wall neoplastic pathology is associated with high surgical morbidity and can result in full thickness defects hard to reconstruct. The goals of a successful chest wall reconstruction are to restore the chest wall rigidity, preserve pulmonary mechanic and protect the intrathoracic organs minimizing the thoracic deformity. In case of large full thickness defects synthetic, biologic or composite meshes can be used, with or without titanium plate to restore thoracic cage rigidity as like as more recently the use of allograft to reconstruct the sternum. After skeletal stability is established full tissue coverage can be achieved using direct suture, skin graft or local advancement flaps, pedicled myocutaneous flaps or free flaps. The aim of this article is to illustrate the indications, various materials and techniques for chest wall reconstruction with the goal to obtain the best chest wall rigidity and soft tissue coverage.

A technique for pediatric chest wall reconstruction using custom-designed titanium implants: Description of technique and report of two cases

Purpose We present a surgical technique for chest wall reconstruction using custom-designed titanium implants developed for two female patients to provide both chest wall symmetry and adequate stability for staged breast reconstruction.MethodsA retrospective review was performed for two adolescent female patients with large chest wall defects who underwent the described technique. The etiology of the chest wall deficiency was secondary to Poland’s syndrome in one patient, and secondary to surgical resection of osteosarcoma in the other patient. For each patient, a fine-cut computed tomography scan was obtained to assist with implant design. After fabrication of the prosthesis, reconstruction was performed though a curvilinear thoracotomy approach with attachment of the implant to the adjacent ribs and sternum. Wound closure was obtained with use of synthetic graft material, local soft tissue procedures, and flap procedures as necessary.ResultsThe two patients were followed post-operatively for 35 and 38 months, respectively. No intra-operative or post-operative complications were identified. Mild scoliosis that had developed in the patient following chest wall resection for osteosarcoma did not demonstrate any further progression following reconstruction.ConclusionsWe conclude that this technique was successful at providing a stable chest wall reconstruction with satisfactory cosmetic results in our patients.

Arena Roof Technique for Complex Reconstruction After Extensive Chest Wall Resection

Extensive primary resections or redos may produce significant chest wall defects requiring creative reconstructions in order to avoid reduction of the intrathoracic volume. We describe the successful use of an innovative technique for chest wall reconstruction based on the concept of roof coverage of sport arenas. Infact, titanium plates are anchored to the residual ribstumps along the parasternal and paravertebral lines. The acellular collagen matrix prosthesis was sutured to the free edges of the same titanium plates to create a roof, reproducing the chest wall dome geometric configuration. A 36-year-old female patient was diagnosed with an extensive desmoid tumor involving the lateral segments of second to fifth ribs on the right side. The arena roof technique allowed for adequate expansion of the uninvolved lung and optimal chest wall functional recovery.

Split-thickness Cartilage Grafts for Chest Wall Reconstruction in Pentalogy of Cantrell

We describe a simple technique for chest wall reconstruction in pentalogy of Cantrell using split-thickness cartilage grafts. This technique provides a robust reconstruction, gives immediate and excellent cosmetic results, allows for skeletal and tissue growth, and avoids the use of synthetic material.

The external dermo glandular mammary flap: an alternative technique for chest wall reconstruction

Chest wall reconstructions can be challenging procedures especially after large thoracic defects generated by cancer resections. We report a case of an anterior chest wall defect after a recurrent metaplastic carcinoma of the breast 7 years after the mastectomy. A partial sternectomy was carried out in conjunction with resection of the first four right ribs. Chest wall skeletal defects were reconstructed with polypropylene mesh folded in four under tension. Soft tissue reconstruction was performed with an external controlateral dermoglandular flap after a mammoplasty. The 12 × 38 cm flap remained on the external mammary vascularization and was tunneled to cover the defect. After follow-up, the patient remains disease-free with satisfactory quality of life. This new breast flap can expand the therapeutic arsenal to cover such chest wall defects offering, at the same time, a mammoplasty.

Current techniques for chest wall reconstruction: Expanded possibilities for treatment : McKanna RJ Jr, Mountain CF, McMurtrey MJ, Larson D, Stiles QR. Department of Thoracic Surgery, University of Texas, M.D. Anderson Hospital, Houston, TX 77030. Ann Thorac Surg 1988;46:508-12

Current techniques for chest wall reconstruction: Expanded possibilities for treatment : McKanna RJ Jr, Mountain CF, McMurtrey MJ, Larson D, Stiles QR. Department of Thoracic Surgery, University of Texas, M.D. Anderson Hospital, Houston, TX 77030. Ann Thorac Surg 1988;46:508-12

Current Techniques for Chest Wall Reconstruction: Expanded Possibilities for Treatment

Myocutaneous flaps and prosthetic materials have greatly facilitated reconstruction after massive chest wall resection. This series includes 112 such procedures. Latissimus dorsi, rectus abdominis, omental, pectoralis major, and contralateral breast flaps were used in 80 patients. Early in the series, 3 flaps were lost because of technical problems. Minor areas of incomplete healing that resolved completely with local wound care occurred in 16 of 80 flaps. Skeletal reconstruction was performed in 82 patients without complication. Marlex mesh was used for flat surfaces, and Marlex mesh with methyl methacrylate was used for the sternum and the curved surface of the lateral chest wall. These results have allowed an expansion of the indications for chest wall resection to include the curative treatment of primary chest wall tumors and palliative treatment for breast cancer patients with osteoradionecrosis, local recurrence (in select patients), chest wall infection, and tumors metastatic to the chest wall.