Titanium plates and Dualmesh: a modern combination for reconstructing very large chest wall defects

Area of Science:

• Thoracic Surgery
• Surgical Oncology
• Biomaterials Engineering

Background:

• Reconstructing large chest wall defects after lung cancer or primary tumor resection is challenging.
• Defect size significantly impacts postoperative morbidity.
• Novel reconstruction techniques are crucial for improving patient outcomes.

Purpose of the Study:

• To evaluate the efficacy and safety of chest wall reconstruction using expanded polytetrafluoroethylene (ePTFE) mesh and titanium plates.
• To assess the outcomes of this combined approach in patients with large full-thickness chest wall defects.

Main Methods:

• A retrospective analysis of 19 patients who underwent chest wall reconstruction between 2006 and the present.
• Utilized a 2-mm thick ePTFE mesh, tailored to the defect and secured under tension.
• Integrated titanium plates for rib fixation, with some cases requiring additional titanium bars or vertical devices.

Main Results:

• Seventeen patients achieved complete R0 resection, involving 3-9 ribs and the sternum in 7 cases.
• The technique required 1-4 horizontal titanium bars on average.
• Complications included 2 infections (1 requiring explantation), 1 case of partial skin necrosis, and 1 instance of respiratory failure.

Conclusions:

• Titanium rib osteosynthesis combined with ePTFE mesh (Dualmesh) provides a feasible and safe one-stage solution for major chest wall defects.
• This approach demonstrates promising initial results for complex chest wall reconstruction.