Reconstruction of the thoracic wall-long-term follow-up including pulmonary function tests.
OBJECTIVE
Thoracic wall reconstructions have become a standard procedure for the reconstructive plastic surgeon in the larger hospital setting, but detailed reports about long-term results including pulmonary function and physical examination are rare.


METHODS
The data of 92 consecutive patients with full thickness chest wall resections were acquired from patient's charts and contact to patients, their relatives or general practitioners, with special reference to treatment and clinical course. At a mean follow-up of 5.5 years, 36 patients were examined physically and interviewed. Twenty-seven of them underwent additional pulmonary function tests. Kaplan-Meier method was used to calculate survival. Regression tests were undertaken to identify factors influencing the outcome.


RESULTS
Postoperative complications were observed in 42.4%, but neither mesh implantation nor the size of the defect contributed significantly. The 5-year mortality was worse for patients with recurrent mamma carcinoma (90.6%) than for patients with soft tissue sarcoma (56.3%). No medical history or operation parameter (resection size and localization) besides the general patients' conditions increased mortality. Pulmonary function parameters were only moderately reduced and not significantly affected by the resections' size or its localization. Majority of patients suffer from sensation disorders and motion-dependent pain, which contributed significantly to hypoxemia. Quality-of-life parameters were significantly reduced compared to the healthy control group but similar to the control group with cancer according to the Short Form-36 protocol. We could not detect a relevant decrease in quality of life comparing post- to preoperative values.


CONCLUSIONS
Thoracic wall reconstruction provides sufficient thoracic wall stability to maintain pulmonary function, but postoperative pain and sensation disorders are considerable. However, chest wall repair can contribute to palliation and even cure after full-thickness resections.
Daigeler
Adrien
A
Department of Plastic Surgery, Burn Center, Hand surgery, BG University Hospital Bergmannsheil, Ruhr-University Bochum, Buerkle-de-la-Camp-Platz 1, 44789, Bochum, Germany. adrien.daigeler@rub.de
Druecke
Daniel
D
Hakimi
Mitra
M
Duchna
Hans-Werner
HW
Goertz
Ole
O
Homann
Heinz-Herbert
HH
Lehnhardt
Marcus
M
Steinau
Hans-Ulrich
HU
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001859:Bone Neoplasms / Q000601:surgery*; D001943:Breast Neoplasms / Q000601:surgery*; D002648:Child; D005260:Female; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000601:surgery; D019736:Prostheses and Implants; D011788:Quality of Life; D019651:Plastic Surgery Procedures / Q000379:methods*; D012129:Respiratory Function Tests; D012509:Sarcoma / Q000601:surgery*; D013524:Surgical Flaps; D013530:Surgical Wound Infection / Q000453:epidemiology; D035441:Thoracic Wall / Q000601:surgery*; D055815:Young Adult