Chest wall resection---alloplastic replacement

Our plain-English summary of Chest wall resection---alloplastic replacement, by L.H. Lampl, H. Loeprecht (The Thoracic and Cardiovascular Surgeon, 1988).

The study

• Authors: L.H. Lampl, H. Loeprecht
• Journal: The Thoracic and Cardiovascular Surgeon
• Published: 1988;36(3):157-8
• Cited by: 13 articles, as counted by NIH iCite
• Read it: PubMed · Publisher

Abstract

In a retrospective study of 302 patients, who were operated on in our centre between 12/85 and 9/87, 25 patients required a chest wall resection. The most frequent indication (11 times) was an infiltration of the thoracic wall by bronchial carcinoma. 8 times we resected a primary rib tumour, in rarer cases a thoracic wall resection was required for mesothelioma, echinococcus alveolaris and tuberculoma. In 10 patients the defect was too small to require a patch. Initially we applied Marlex-mesh and Vicryl-mesh to cover the defects. In our last 10 cases GORE-TEX-2 mm-patch was used. The technical ease of the method, the mechanical stability and durability, the tightness for air and fluid and the positive tissue response speaks for the continued application of this material. Additional methods such as myocutaneous flaps are not necessary and should only be used in complex defects.

In plain English

This was a retrospective report from a surgical clinic at the Central Hospital in Augsburg, West Germany, on removing part of the chest wall and the materials used to repair the gap. Between 12/85 and 9/87 (the dates as the article gives them) the surgeons performed 302 thoracotomies (chest operations), and 25 patients (21 men, 4 women) had a chest wall resection. The most common reason was lung (bronchogenic) cancer growing into the chest wall (11 patients), then primary rib tumours (8). Mesothelioma, type not stated, was the reason in 3 patients. The article did not discuss asbestos. In 10 patients the defect was too small to need a patch. The first 5 repairs used Vicryl or Marlex mesh and the last 10 used a 2 mm GORE-TEX patch. One patient died of bleeding soon after surgery. Uneventful healing was reported in 24 cases. One patch was removed 3 months later after a staphylococcal infection and fistula. The authors concluded that the GORE-TEX patch's properties supported its continued use, and that muscle flaps should be kept for complex defects.

We wrote this plain-English summary from the full article with the help of AI, and a second AI model checked each sentence against the article. It is not the authors' wording; the abstract and the article are their own account.

What the study did and found

• Design: Retrospective review of the surgeons' own chest wall resection cases (a surgical case series)
• Who was studied: 25 patients (21 male, 4 female) who had chest wall resections among 302 thoracotomies performed at the authors' surgical clinic, Central Hospital Augsburg, West Germany (FRG), between 12/85 and 9/87. The oldest patient was 80; the youngest age is unclear in the scanned text.
• Exposure: No asbestos or other exposure was studied. The article concerns surgical repair materials (Vicryl mesh, Marlex mesh, 2 mm GORE-TEX patch). Mesothelioma was one reason for surgery, in 3 patients.
• Main results:
  • Reasons for chest wall resection among the 25 patients: 8 primary rib tumours, 11 chest wall invasion by bronchogenic carcinoma, 3 mesothelioma, 1 echinococcus alveolaris, 1 tuberculoma of the rib, and 1 ossified plate removed for decortication after repeated empyema operations
  • In 10 patients the defect was too small to need replacement with a patch. The other 15 were reconstructed.
  • Of the 15 reconstructions, the first 5 used Vicryl mesh (2) or Marlex mesh (3), and the last 10 consecutive cases used a 2 mm GORE-TEX patch. No prophylactic antibiotics were given.
  • All patients except one (who needed ventilation for 2 days) had the breathing tube removed the evening after surgery or the next morning. No tracheotomy was needed.
  • The chest wall was stable, with no paradoxical movement. One Marlex mesh patient, whose chest wall and left lung were removed together, had marked air and fluid under the skin, treated with compressive dressings for 3 days.
  • One patient died from hemorrhage in the early postoperative period
  • Primary and uneventful healing was reported in 24 cases
  • One patient had a staphylococcal wound infection. The patch could not be saved and was removed 3 months later after a fistula developed. Further healing was uneventful, and the authors described the GORE-TEX patch as very easy to remove.
• The authors' conclusion: The authors concluded that the GORE-TEX patch's technical ease, mechanical stability and durability, tightness for air and fluid, and positive tissue response supported its continued use. In their view, additional methods such as myocutaneous flaps are not necessary and should be reserved for complex defects. They were not convinced the patch should be used where there is infection.
• Limitations the authors state:
  • The authors stated the report does not deal with repair of large full-thickness chest wall defects. All defects in this series were partial-thickness.

Topics

Medical terms in this study, explained in our Lexicon: Carcinoma, Mesothelioma.

Related studies

• Chest wall stabilization using plate fixation — J.E. Sherman, A. Salzberg, et al. (1988)
• Long-term results of chest wall reconstruction with DualMesh — T. Nagayasu, N. Yamasaki, et al. (2010)
• Chest wall resection for mesothelioma recurrence after surgery — P. Bertoglio, O. Fanucchi, et al. (2016)
• Tumor extension along chest wall tract after diagnostic intervention in malignant pleural mesothelioma — F. Chen, A. Yoshizawa, et al. (2011)
• Chest wall tumour following iodized talc pleurodesis — J.W. Jackson, M.H. Bennett (1973)
• Angiosarcoma of the chest wall — T. Suzuki, S. Suzuki, et al. (1996)

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