title: Chest-wall reconstruction in case of infection of the operative site: is there any interest in titanium rib osteosynthesis?
abstract: OBJECTIVE
  To describe the management of thoracic reconstructions in the presence of primary chest-wall infection (PCWI) or secondary deep chest-wall infection (SCWI), focussing on local tolerance of a titanium rib osteosynthesis system.
  
  
  METHODS
  PCWI included infected chest wall tumours (CWT), infected T3 non-small-cell lung carcinoma (NSCLC) and open flail chest. SCWI was defined by deep infection of previous thoracic-wall reconstructions. Infection was identified by preoperative bacterial analysis of the tumour or surgical site. In PCWI, a one-step procedure combined extensive resection of infected tissues and rigid reconstruction of the defect; skeletal rigidity was achieved using titanium implants. In SCWI, we removed all synthetic material except titanium implants. In both groups, the surgical field was thoroughly cleaned and implants were wrapped or covered by flaps.
  
  
  RESULTS
  From January 2005 to December 2011, 11 patients (54 ± 10.2 years) with either PCWI (3 CWT, 3 T3 NSCLC, 1 open flail chest) or SCWI (3 CWT, 1 funnel chest) were treated. Infection was polymicrobial in all but 1 case. Bacteria observed in PCWI patients were multidrug resistant. In PCWI, we resected 4.2 ± 0.6 ribs en bloc with the lung (n = 5), the skin and the pectoralis major and then used mesh and 2.1 ± 1.2 titanium implants for reconstruction (n = 6). The mean defect was 1154.4 ± 318 cm(3). Surgical SCWI management removed polytetrafluoroethylene-mesh and preserved the titanium implants. A Vicryl mesh (n = 3) and greater omentum flap (n = 3) were added. One of the 2 postoperative deaths in the PCWI group was related to infection recurrence. No other patient had infection at the 6-month follow-up with leucocyte-labelled scintigraphy.
  
  
  CONCLUSIONS
  Titanium rib osteosynthesis is reliable in two complex and life-threatening situations: PCWIs and SCWIs. In combination with a flap, this allows rapid, reliable, rigid reconstruction of infected full-thickness chest-wall defects in a single-step procedure.
authors: Division of Thoracic Surgery and Division of Cardiothoracic Radiology, University Hospital Arnaud de Villeneuve, Montpellier, France.
authors: Jean-Philippe
authors: JP
authors: Berthet
authors: Laurence
authors: L
authors: Solovei
authors: Olivier
authors: O
authors: Tiffet
authors: Abel
authors: A
authors: Gomez-Caro
authors: Sébastien
authors: S
authors: Bommart
authors: Ludovic
authors: L
authors: Canaud
authors: Pierre
authors: P
authors: Alric
authors: Charles-Henri
authors: CH
authors: Marty-Ané
mesh_terms: D000328:Adult; D005260:Female; D005593:Fracture Fixation, Internal / Q000295:instrumentation* / Q000379:methods; D006801:Humans; D008297:Male; D008875:Middle Aged; D009984:Orthopedic Fixation Devices; D011446:Prospective Studies; D019651:Plastic Surgery Procedures / Q000295:instrumentation* / Q000379:methods; D012272:Ribs / Q000601:surgery; D013530:Surgical Wound Infection / Q000601:surgery*; D013896:Thoracic Diseases / Q000601:surgery; D019616:Thoracic Surgical Procedures / Q000295:instrumentation* / Q000379:methods; D035441:Thoracic Wall / Q000601:surgery*; D014025:Titanium
chemical_list: D014025:Titanium
keywords: Chest wall; Chest wall prosthesis; Chest-wall infection; Lung cancer; Primary tumours