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Thoracic wall reconstruction for primary malignancies in children: short- and long-term results
C Dingemann1, C Linderkamp, J Weidemann
1Hannover Medical School, Department of Pediatric Surgery, Hannover, Germany. dingemann.carmen@mh-hannover.de
Insights
Reconstructing pediatric chest walls after malignant tumor resection using non-rigid prosthetics is safe and effective. Rigid materials may dislocate, and scoliosis requires monitoring post-surgery.
Area of Science:
- Pediatric oncology
- Thoracic surgery
- Reconstructive surgery
Background:
- Primary thoracic wall malignancies are rare in children.
- Surgical resection often results in large defects requiring complex reconstruction.
- Limited data exists on pediatric chest wall reconstruction procedures.
Purpose of the Study:
- To report the experience of surgical treatment and outcomes in children undergoing chest wall resection and reconstruction for primary malignant tumors.
- To evaluate the safety and efficacy of different reconstructive materials and techniques in pediatric patients.
- To identify postoperative complications and long-term results, including the incidence of scoliosis.
Main Methods:
- Retrospective study of 8 pediatric patients with primary malignant chest wall tumors.
- Resection of thoracic wall tumors involving rib removal.
- Reconstruction using rigid (titanium bar) and/or non-rigid (Goretex, Vicryl, Tutopatch) prosthetic materials.
- Addition of muscle flap repair in some cases.
- Evaluation of postoperative complications and long-term outcomes, including scoliosis (Cobb angle).
Main Results:
- 8 children underwent tumor resection with a mean of 3 ribs resected.
- Non-rigid materials were used in 6 patients, rigid in 2.
- Superficial wound infection occurred in 2 patients; one titanium bar dislocated.
- No prosthetic material infections or perioperative mortality.
- At mean follow-up of 37.5 months, 6 patients survived; 2 died from recurrence.
- Mild scoliosis was detected in 2 surviving patients (33%).
Conclusions:
- Non-rigid prosthetic material reconstruction is safe and effective for pediatric malignant thoracic wall tumors.
- Rigid prosthetic material may be associated with dislocation complications.
- Scoliosis is a potential long-term complication requiring monitoring after chest wall reconstruction.
Aim:
Primary thoracic wall malignancy is a rare and diverse entity in children. Surgical treatment commonly involves major chest wall resection causing large defects requiring complex reconstruction. In adults, the use of alloplastic and/or xenogenic materials and muscle flap repair is well established. However, literature provides only little information on procedures in children. We report our experience in 8 consecutive children who underwent chest wall resection and reconstruction with regard to surgical treatment and outcome.
Patients And Methods:
Retrospective study of all children with primary malignant chest wall tumors requiring rib resection and reconstruction with prosthetic material performed in our institution between November 2002 and April 2010. Endpoints were postoperative complications and long-term results, focusing on scoliosis defined radiologically by the Cobb angle.
Results:
8 children (7 male, 1 female) with a median age of 10.6 (4.1-18.9) years underwent resection of thoracic wall tumors. A mean number of 3 (1-5) ribs were resected. Stability was obtained using rigid prosthetic material (STRATOS™ titanium bar) in 2 patients and/or non-rigid prosthetic material (Goretex® patch in 6 patients, Vicryl® patch in 3 patients, Tutopatch® in 1 patient). A muscular flap was added in 5 patients. Postoperative complications included superficial wound infection (n = 2) and dislocation of a titanium bar necessitating removal in 1 patient. No infections of the prosthetic material were observed. No perioperative mortality occurred. At a mean follow-up of 37.5 (4-97) months, 6 patients were alive. 2 patients died due to early tumor recurrence. Mild scoliosis (Cobb angle 10-20°) was detected in 2 of the surviving patients (33%).
Conclusion:
Surgical reconstruction after resection of malignant thoracic wall tumors using non-rigid prosthetic material is safe and effective in pediatric patients, whereas rigid prosthetic material might dislocate. Scoliosis represents a long-term complication after chest wall reconstruction and should be monitored during routine follow-up.
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