Reconstruction of chest wall defects.
A series of 61 consecutive procedures of chest wall resection and reconstruction in 58 patients during the period between August, 1986 and December, 1990 is reported. The ages ranged between 6-77 years. The chest wall resection was indicated for malignant affections in 54 cases. Among these, there were 24 patients with bronchial carcinoma invading the chest wall, 17 patients with primary or metastatic sarcoma, 11 patients with recurrent breast cancer and 3 with cancer metastases of varying origin. Pulmonary resection included pneumonectomy in 8 cases, lobectomy in 19, segmental and wedge resections in 26. In the majority of resections, the reconstruction was accomplished without implants. In cases with full thickness removal of the chest wall, the plane of the rib cage and/or the sternum was reconstructed using Vicryl mesh (n = 7), PTFE soft tissue patch (n = 11), marlex-mesh (n = 1), or methyl-methacrylate (n = 3). There was one case of hospital mortality, 6 weeks postoperatively, due to neurological failure from an independent preoperatively undiagnosed brain tumor. There were 4 reoperations: one early and one late (4 months) infection, one case of limited superficial necrosis of a flap and one with chronic lymphous drainage from a large myocutaneous flap. In no instance was primary postoperative ventilation therapy necessary. Mechanical ventilation was instituted only on day 8 in the patient who accounts for the mortality in this series. In the presence of primary infection, the greater omentum was used for the restoration of the integument.
Hasse
J
J
Department of Thoracic Surgery, University of Freiburg, Germany.
D000230:Adenocarcinoma / Q000000981:diagnostic imaging / Q000601:surgery; D000293:Adolescent; D000328:Adult; D000368:Aged; D001940:Breast / Q000601:surgery; D001943:Breast Neoplasms / Q000000981:diagnostic imaging / Q000601:surgery; D002283:Carcinoma, Bronchogenic / Q000601:surgery; D002648:Child; D005260:Female; D006801:Humans; D008175:Lung Neoplasms / Q000000981:diagnostic imaging / Q000601:surgery; D008297:Male; D008637:Mesenchymoma / Q000601:surgery; D008875:Middle Aged; D011013:Pneumonectomy; D019736:Prostheses and Implants; D013249:Sternum / Q000601:surgery; D013899:Thoracic Neoplasms / Q000000981:diagnostic imaging / Q000556:secondary / Q000601:surgery*; D013903:Thoracic Surgery; D014057:Tomography, X-Ray Computed