2Department of Thoracic Surgery, Sincan Training and Research Hospital, Ankara, Turkey DOI : 10.26663/cts.2023.0023 Viewed : 956 - Downloaded : 328 Background: Chest wall tumors can be malignant and benign and present as primary or metastatic lesions. For the definitive treatment of malignant thoracic wall tumors, the surgical margin should be established at a distance of at least 4 cm from the tumor. A 1-2 cm distance from the tumor is often sufficient in benign or low-grade malignancies. Repairing the deformity with prosthetic materials in 3 or more rib resections (>30 cm) is recommended. In resections containing four or more ribs, the mesh should be supported with metallic rib bars screwed to the periphery of the defect.
Materials and Methods: Thoracic wall resection was performed on 285 patients between 2008 and 2019 in the Department of Thoracic Surgery of Ankara Atatürk Sanatoryum Training and Research Hospital. Repair with prosthetic graft was performed in 70 cases, and thoracic wall resection was performed in 215 patients without using mesh. The results of 50 patients who underwent thoracic wall reconstruction with a prosthetic graft were evaluated retrospectively.
Results: The female/male ratio in those using mesh is 0.47; the mean age is 52.5 (14-76 years); the tumor size (mean long diameter) is 11 cm (4-18 cm); the number of removed ribs is 2.5 (1-5 pieces) is Sternal resection was performed in 2 patients, sternum resection in 1 patient, left clavicle partial resection, right clavicle partial resection, and first and second ribs of the left side resection. Partial excision of the clavicle and first rib was performed in 1 patient. Polypropylene mesh in 28, PTFE mesh in 20, and polyglactin mesh in 2 patients were used. The mean postoperative hospital stay was 10.6 days (2-58 days), and the mean follow-up period was 16.6 months (0-96 months, median 7 months). Complications developed in 10 patients (20.0%). Three patients underwent revision surgery; one was operated on for empyema at four months, and the patch was removed. The others were performed at the 16th and 30th months due to recurrence. Mortality developed in 4 patients in long-term follow-ups.
Conclusions: Polypropylene mesh can cause wrinkles and folds as it shows less stretch when suturing than Polytetrafluoroethylene (PTFE). In addition to the difficulties of providing a smooth surface, it also causes the passage of fluid and air in the pleural space from the pores to the subcutaneous space. PTFE patches are frequently used, non-permeable, flexible, high tissue compatibility, durable and robust, but poor body wall integration has been reported. Polypropylene and PTFE mesh comparison results are similar to the literature. Suppose a significant defect (>30 cm2) exists in patients who have undergone thoracic wall resection; reconstruction should be performed to stabilize the thoracic wall, prevent lung hernia, paradoxical breathing, mediastinal structures, and intrathoracic dislocation of the scapula, and provide aesthetically appropriate rib cage contours.
Keywords : chest wall, reconstruction, polyprolen mesh, PTFE, thoracic surgery