title: Titanium plates and Dualmesh: a modern combination for reconstructing very large chest wall defects.
abstract: BACKGROUND
  The reconstruction of large full-thickness chest wall defects after resection of T3/T4 non-small cell lung carcinomas or primary chest wall tumors presents a technical challenge for thoracic surgeons and plays a central role in determining postoperative morbidity. The objective is to evaluate our results in chest wall reconstruction using a combination of expanded polytetrafluoroethylene (ePTFE) mesh and titanium plates.
  
  
  METHODS
  Since 2006, 19 patients underwent reconstruction for wide chest wall defects using a combination of ePTFE mesh and titanium plates. The chest wall reconstruction was achieved by using a layer of 2-mm thickness ePTFE shaped to match the chest wall defect and sewed under maximum tension. The ePTFE is placed close to the lung and fixed onto the bony framework and onto the titanium plate, which is inserted on the ribs.
  
  
  RESULTS
  Seventeen patients underwent a complete R0 resection with the removal of 3 to 9 ribs (mean, 4.8 ribs), including the sternum in 7 cases. Reconstruction required 1 to 4 horizontal titanium bars (mean, 1.7 bars). In 1 patient, a vertical titanium device was implanted for a large posterolateral defect. There were 2 cases of infection, which required explantation of the osteosynthesis system in 1 patient. One patient had partial skin necrosis that required prompt debridement. One patient had a major complication in the form of respiratory failure.
  
  
  CONCLUSIONS
  Our experience and initial results show that titanium rib osteosynthesis in combination with Dualmesh can easily and safely be used in a one-stage procedure for major chest wall defects.
authors.affiliation: Department of Thoracic Surgery, Hospital Arnaud de Villeneuve, Montpellier, France. jeanphilippe.berthet@gmail.com
authors.forename: Jean Philippe
authors.initials: JP
authors.lastname: Berthet
authors.forename: Ludovic
authors.initials: L
authors.lastname: Canaud
authors.forename: Thomas
authors.initials: T
authors.lastname: D'Annoville
authors.forename: Pierre
authors.initials: P
authors.lastname: Alric
authors.forename: Charles-Henri
authors.initials: CH
authors.lastname: Marty-Ane
mesh_terms: D000328:Adult; D000368:Aged; D001860:Bone Plates; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011138:Polytetrafluoroethylene; D019651:Plastic Surgery Procedures / Q000379:methods*; D013526:Surgical Mesh; D013899:Thoracic Neoplasms / Q000601:surgery; D035441:Thoracic Wall / Q000601:surgery*; D014025:Titanium
chemical_list: D011138:Polytetrafluoroethylene; D014025:Titanium