title: The combination of polytetrafluoroethylene mesh and titanium rib implants: an innovative process for reconstructing large full thickness chest wall defects.
abstract: OBJECTIVE
  The reconstruction of large full thickness chest wall defect after resection of T3/T4 non-small cell lung cancer (NSCLC) or primary chest wall tumours presents a technical challenge for thoracic surgeons and is a critical factor in determining post-operative outcome. When the defect is large, complications are common with a 27% mean rate of respiratory morbidity.
  
  
  METHODS
  Since 2006, 31 patients underwent reconstruction for wide chest wall defects using titanium implants and strong mesh. The reconstruction was achieved using a layer of polytetrafluoroethylene or a XCM biologic tissue mesh shaped to match the defect and sutured under maximum tension to re-establish the skeletal continuity. The mesh was placed close to the lung and was fixed onto the bony framework and onto the titanium plate. In one case, we used XCM biologic tissue because of a large infected T3 NSCLC. A horizontal titanium rib osteosynthesis system was used to reestablish the rigidity of the thoracic wall by bridging the defect except for one case in which we use a vertical rib osteosynthesis system.
  
  
  RESULTS
  Twenty-six patients underwent a complete R0 resection with the removal of a mean of 4.67 ± 1.5 [3-9] ribs, including the sternum in 14 cases. The mean defect area was 198 ± 91.2 [95-400] cm&sup2;. Reconstruction required a mean of 2.06 ± 1.1 [1-4] titanium plates. There were two cases of deep wound infection that required surgical removal of the osteosynthesis system in one patient. Only one patient developed a major complication in the form of respiratory failure. There were two postoperative deaths neither of which was directly related to the surgical procedure.
  
  
  CONCLUSIONS
  Our experience and initial results show that titanium rib osteosynthesis in combination with strong biologic or synthetic mesh can easily and safely be used in a one-stage procedure for the reconstruction of major chest wall defects.
authors.affiliation: Department of Thoracic Surgery, University Hospital Arnaud de Villeneuve, Montpellier, France. jeanphilippe.berthet@gmail.com
authors.forename: Jean-Philippe
authors.initials: JP
authors.lastname: Berthet
authors.forename: Jean-Marie
authors.initials: JM
authors.lastname: Wihlm
authors.forename: Ludovic
authors.initials: L
authors.lastname: Canaud
authors.forename: Frédérique
authors.initials: F
authors.lastname: Joyeux
authors.forename: Catalin
authors.initials: C
authors.lastname: Cosma
authors.forename: Keira
authors.initials: K
authors.lastname: Hireche
authors.forename: Pierre
authors.initials: P
authors.lastname: Alric
authors.forename: Charles-Henri
authors.initials: CH
authors.lastname: Marty-Ané
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002289:Carcinoma, Non-Small-Cell Lung / Q000601:surgery; D015331:Cohort Studies; D003131:Combined Modality Therapy / Q000379:methods; D005260:Female; D005500:Follow-Up Studies; D005602:France; D017052:Hospital Mortality / Q000639:trends; D006801:Humans; D008175:Lung Neoplasms / Q000601:surgery; D008297:Male; D008875:Middle Aged; D011138:Polytetrafluoroethylene / Q000494:pharmacology*; D011183:Postoperative Complications / Q000401:mortality / Q000503:physiopathology; D019736:Prostheses and Implants; D019651:Plastic Surgery Procedures / Q000379:methods* / Q000401:mortality; D012189:Retrospective Studies; D012272:Ribs / Q000601:surgery; D018570:Risk Assessment; D013524:Surgical Flaps / Q000098:blood supply; D013526:Surgical Mesh; D015996:Survival Rate; D035441:Thoracic Wall / Q000503:physiopathology / Q000601:surgery*; D013908:Thoracotomy / Q000009:adverse effects* / Q000379:methods; D013997:Time Factors; D014025:Titanium; D016896:Treatment Outcome; D014945:Wound Healing / Q000502:physiology
chemical_list: D011138:Polytetrafluoroethylene; D014025:Titanium