Chest wall resection and reconstruction: analysis of 11 cases after methylmethacrylate reconstruction

Patients with extensive resection of the chest wall, followed by reconstruction with methylmethacrylate and double prolene mesh in the form of "sandwich" prosthesis. Substitutes were assessed prospectively as chest wall defects continue to present a complicated treatment scenario for thoracic and reconstructive surgeons.

To evaluate the results of eleven patients who underwent chest wall resection and reconstruction.

Eleven patients were prospectively reviewed who underwent chest wall resection and reconstruction at National Cancer Institute Cairo University. Among them, 7 were male and 4 female. The mean age was 34.5 (SDV +/- 19.8) years. The indications for resection were primary chest wall tumor in 7 patients (63.7%), recurrence of breast cancer 2 (18.2%), lung cancer with invasion of chest wall 1 (9.1%) and pleuroblastoma 1 (9.1%).

The mean number of rib resected was 4.18 +/- 1.16 ribs (3-6). Concomitant resection was done in 6 patients; including lung resection 2, partial resection of diaphragm 2, lateral clavicle with forequarter amputation 1 and partial sternectomy 1. All patients underwent skeletal reconstruction (SR) with methylmethacrylate and double prolene mesh in the form of"sandwich" prosthesis. Simultaneous SR and soft tissue reconstruction (STR) were performed in 7 patients 63.7%. Five patients (45.5%) developed postoperative complications with no perioperative mortality. Follow-up was carried out for a mean period of 18.7 months (11-36). Three patients developed relapse (27.3%), local recurrence in two cases and bone metastases in one case.

Chest wall resection followed immediately by reconstruction utilizing synthetic mesh with a filler of methylmethacrylate with or without local or pedicled muscle flaps can be performed as a safe, effective one-stage surgical procedure for major chest wall defects which prevents paradoxical movement of chest wall and overcomes deformity.