Long-term results of chest wall reconstruction with DualMesh

Our plain-English summary of Long-term results of chest wall reconstruction with DualMesh, by T. Nagayasu, N. Yamasaki, T. Tagawa, et al (Interactive Cardiovascular and Thoracic Surgery, 2010).

The study

• Authors: T. Nagayasu, N. Yamasaki, T. Tagawa, T. Tsuchiya, T. Miyazaki, A. Nanashima, M. Obatake, H. Yano
• Journal: Interactive Cardiovascular and Thoracic Surgery
• Published: 2010;11(5):581-4
• Cited by: 21 articles, as counted by NIH iCite
• Read it: PubMed · Publisher

Abstract

The aim of this study was to evaluate the clinical outcomes of chest wall reconstruction using a new, expanded polytetrafluoroethylene prosthesis, 'DualMesh'. Between December 2005 and March 2010, chest wall reconstruction using 2-mm DualMesh was performed in 11 patients. The indication for resection was primary lung cancer in six patients, malignant mesothelioma in one patient, recurrent lung cancer in one patient, recurrent invasive thymoma in one patient, postirradiated osteomyelitis in one patient, and chondro-hamartoma in one patient. The mean observation period was 23 months, and four cases were observed for more than three years. There were no operative deaths and no wound infections. There were two postoperative complications: prolonged air leakage occurred in a patient with pulmonary emphysema who underwent right lower lobectomy, and slight paradoxical respiration occurred in the patient who underwent resection of the entire sternal body for osteomyelitis. Follow-up chest computed tomography was performed routinely. No dehiscence occurred in any cases. Chest wall reconstruction using DualMesh demonstrated acceptable durability and biocompatibility, even after long-term follow-up. DualMesh has the potential to become an ideal prosthesis for the bony chest wall as an alternative to conventional polytetrafluoroethylene or polypropylene grafts.

In plain English

This report from one surgical department in Nagasaki, Japan described 11 patients whose chest wall was rebuilt with a 2-mm sheet of DualMesh, a synthetic expanded polytetrafluoroethylene material, between December 2005 and March 2010. Most had lung cancer; one had malignant mesothelioma. The article did not discuss asbestos. There were no operative deaths and no wound infections. Two patients had complications. One had prolonged air leakage. The other, whose entire sternal body was removed for osteomyelitis, had slight paradoxical breathing that faded within a few months. Mean follow-up was 23 months, and four patients were followed for more than three years. Follow-up imaging showed no dehiscence (the repair coming apart) and no mesh shrinkage. The mesothelioma patient had a left pleuro-pneumonectomy, had no complications, and was listed as dead at 11 months; no cause was stated. The authors concluded that the mesh showed acceptable durability and biocompatibility. They noted the small number of cases, the lack of any randomized comparison, and the need for longer follow-up.

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: Institutional report (single-centre surgical case series) describing outcomes of chest wall reconstruction
• Who was studied: 11 patients (seven males, four females; mean age 66, range 48 to 82) operated on between December 2005 and March 2010 at the Division of Surgical Oncology, Nagasaki University, Japan. Diagnoses were primary lung cancer (6), malignant mesothelioma (1), recurrent lung cancer (1), recurrent invasive thymoma (1), post-irradiation osteomyelitis (1) and chondro-hamartoma (1).
• Exposure: No asbestos exposure was studied. The intervention studied was chest wall reconstruction with a 2-mm DualMesh expanded polytetrafluoroethylene (ePTFE) prosthesis.
• Main results:
  • Among all 11 patients there were no operative deaths and no wound infections.
  • Case no. 3 (pulmonary emphysema, right lower lobectomy) had prolonged air leakage; the chest drain was removed 12 days after surgery.
  • Case no. 6 (entire sternal body resected for osteomyelitis) had slight paradoxical respiration that diminished a few months after surgery.
  • The mean observation period was 23 months, and four cases were observed for more than three years.
  • On routine follow-up chest CT, no dehiscence occurred in any case.
  • None of the cases showed shrinkage of DualMesh on long-term follow-up CT or magnetic resonance imaging.
  • The patient with malignant mesothelioma (case no. 7, female, 68) underwent left pleuro-pneumonectomy with reconstruction of the diaphragm and pericardium. Table 1 lists no postoperative complications and an observation period of 11 months, outcome dead. No cause of death is given.
• The authors' conclusion: The authors concluded that chest wall reconstruction using DualMesh demonstrated acceptable durability and biocompatibility even after long-term follow-up, and that it has the potential to become an ideal prosthesis for the bony chest wall.
• Limitations the authors state:
  • The report had a small number of cases, and no randomized study has compared DualMesh with other prosthetic materials.
  • The authors state that further long-term follow-up and more cases are necessary.

Topics

Medical terms in this study, explained in our Lexicon: Lung Cancer, Malignant Mesothelioma, Emphysema.

Related studies

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• Chest wall resection for mesothelioma recurrence after surgery — P. Bertoglio, O. Fanucchi, et al. (2016)
• En bloc resection of the recurrent pleural mesothelioma and reconstruction of the chest wall after immunotherapy: A case report — C. Qin, Q. Xia, et al. (2023)
• Tumor extension along chest wall tract after diagnostic intervention in malignant pleural mesothelioma — F. Chen, A. Yoshizawa, et al. (2011)
• Polytetrafluoroethylene or Acellular Dermal Matrix for Diaphragmatic Reconstruction? — J.K. Bassuner, D.C. Rice, et al. (2017)
• Morbidity of the abdominal wall resection and reconstruction after cytoreductive surgery and hyperthermic intraperitoneal chemotherapy (CRS/HIPEC) — M.F. Nunez, A. Sardi, et al. (2015)

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