High complication rate with titanium plates for chest wall reconstruction following tumour resection

The reconstruction of the chest wall defect after tumour resection presents a challenge. Titanium rib plates were presented as a reconstruction option due to its biocompatibility, flexibility and pliability. The aim of this study was to evaluate the outcome of single-centre cohort treated with chest wall reconstruction after tumour resections, with a focus on the titanium rib plates reconstruction.

We retrospectively reviewed the data of 26 patients who underwent wide resection for malignancies of the chest wall, where reconstruction was performed using polypropylene mesh, porcine dermal collagen mesh with or without titanium rib plates, operated on between 2012 and 2019. Events being associated with the surgery requiring revision were rated as complications.

Most of the patients had primary tumours (n = 19; 73%). A mean of 3.7 ribs (range: 1-7) was resected. Reconstruction was performed with titanium rib plates (13 patients, 50%), of these 11 were performed with additional mesh grafts. The remaining 13 patients (50%) underwent reconstruction with mesh grafts only. Fourteen patients (54%) developed a complication requiring surgical revision, after a median of 5.5 months. The most common complication was wound healing deficit (n = 4), plate fracture (n = 2), mesh rupture (n = 2), infection (n = 2) and local recurrence (n = 2). The only factor being associated with the development of complications was the usage of a plate (P = 0.015), irrespective of defect size (P = 0.29).

The high complication rate is found when using titanium plates for chest wall reconstruction after tumour resection. A high caution is recommended in choosing the chest wall reconstruction method.