Reconstruction of chest wall defects.

Area of Science:

• Thoracic Surgery
• Surgical Oncology
• Reconstructive Surgery

Background:

• Chest wall resections are complex procedures often necessitated by malignant tumors.
• Reconstruction techniques vary based on the extent of chest wall defect.
• Malignant conditions, including bronchial carcinoma and sarcomas, are primary indications for these surgeries.

Purpose of the Study:

• To report outcomes of a series of chest wall resections and reconstructions.
• To evaluate reconstruction methods, particularly those avoiding synthetic implants.
• To analyze complications and patient outcomes in a consecutive case series.

Main Methods:

• Review of 61 consecutive chest wall resection and reconstruction procedures in 58 patients (1986-1990).
• Analysis of patient demographics, indications for resection (malignant vs. benign), and types of pulmonary resection.
• Description of reconstruction techniques, including non-implant methods and use of Vicryl mesh, PTFE, marlex-mesh, and methyl-methacrylate for full-thickness defects.

Main Results:

• 54 of 58 patients underwent resection for malignant conditions, including lung cancer, sarcoma, and breast cancer.
• Most reconstructions were performed without implants; synthetic materials were used for full-thickness defects in 22 cases.
• Low complication rate with one hospital mortality unrelated to the primary procedure and four reoperations for infection, necrosis, or lymphous drainage.

Conclusions:

• Chest wall resection and reconstruction can be performed with favorable outcomes, even for extensive malignant disease.
• Non-implant reconstruction methods are often feasible and effective.
• Careful surgical planning and management minimize complications, with rare need for prolonged mechanical ventilation.