title: Chest wall reconstruction following resection of large primary malignant tumors.
abstract: Reconstructive procedures following radical resection of large primary malignant chest wall tumors (PMCWT) continue to evolve. Between 1982 and 1993, 32 consecutive patients (18 males/14 females) with a median age of 47 years (range, 12-77) underwent radical resection for large (median 10 +/- 5.4 cm) PMCWTs arising either from the bone (n = 15) or soft tissues (n = 17) of the chest wall. Nine (28%) had previous surgical resection before referral. Sixteen (50%) required extensive skin excision. Twelve sternectomies (5 total and 7 partial) and 20 lateral chest wall resections were performed. In this latter group, 16 patients (80%) had at least three ribs resected. Resection extended to the lung (10 wedge resections, 2 lobectomies and 1 pneumonectomy) in 13 patients, diaphragm in 3, abdominal wall in 2, brachiocephalic and subclavian vessels in 5, superior vena cava in 1 and upper limb in 1. Stability of the chest wall was obtained with prosthetic material in 27 patients, including Marlex (n = 21), polytetrafluoroethylene (PTFE) (n = 4) and polyglactin (n = 2) meshes. After sternectomy, six patients had a methyl methacrylate mesh reinforcement while soft tissue reconstruction was carried out using the pectoralis major muscle (PM), either alone with skin advancement (n = 8) or as a myocutaneous flap in three males (unilateral n = 2, bilateral n = 1) and by a latissimus dorsi (LD) myocutaneous flap in one female. Muscle transposition was used to reconstruct defects of the lateral chest wall and included 10 LD, 6 PM and 2 serratus anterior (SA) muscles, with associated advancement of the diaphragm in two cases.(ABSTRACT TRUNCATED AT 250 WORDS)
authors.affiliation: Department of Thoracic & Vascular Surgery and Heart-Lung Transplantation, Hôpital Marie-Lannelongue (Paris-Sud University), Le Plessis Robinson, France.
authors.forename: A
authors.initials: A
authors.lastname: Chapelier
authors.forename: P
authors.initials: P
authors.lastname: Macchiarini
authors.forename: M
authors.initials: M
authors.lastname: Rietjens
authors.forename: B
authors.initials: B
authors.lastname: Lenot
authors.forename: A
authors.initials: A
authors.lastname: Margulis
authors.forename: J Y
authors.initials: JY
authors.lastname: Petit
authors.forename: P
authors.initials: P
authors.lastname: Dartevelle
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D002648:Child; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D012509:Sarcoma / Q000601:surgery*; D013249:Sternum / Q000601:surgery*; D013524:Surgical Flaps; D013526:Surgical Mesh; D015996:Survival Rate; D013899:Thoracic Neoplasms / Q000401:mortality / Q000601:surgery*