Chest wall reconstruction following resection of large primary malignant tumors

A. Chapelier, P. Macchiarini, M. Rietjens, B. Lenot, A. Margulis, J. Y. Petit, P. Dartevelle

Research output: Contribution to journalArticle

Abstract

Reconstructive procedures following radical resection of large primary malignant chest wall tumors (PMCWT) continue to evolve. Between 1982 and 1993, 32 consecutive patients (18 males/14 females) with a median age of 47 years (range, 12-77) underwent radical resection for large (median 10±5.4 cm) PMCWTs arising either from the bone (n = 15) or soft tissues (n = 17) of the chest wall. Nine (28%) had previous surgical resection before referral. Sixteen (50%) required extensive skin excision. Twelve sternectomies (5 total and 7 partial) and 20 lateral chest wall resections were performed. In this latter group, 16 patients (80%) had at least three ribs resected. Resection extended to the lung (10 wedge resections, 2 lobectomies and 1 pneumonectomy) in 13 patients, diaphragm in 3, abdominal wall in 2, brachiocephalic and subclavian vessels in 5, superior vena cava in 1 and upper limb in 1. Stability of the chest wall was obtained with prosthetic material in 27 patients, including Marlex (n = 21), polytetrafluoroethylene (PTFE) (n = 4) and polyglactin (n = 2) meshes. After sternectomy, six patients had a methyl methcrylate mesh reinforcement while soft tissue reconstruction was carried out using the pectoralis major muscle (PM), either alone with skin advancement (n = 8) or as a myocutaneous flap in three males (unilateral n = 2, bilateral n = 1) and by a latissimus dorsi (LD) myocutaneous flap in one female. Muscle transposition was used to reconstruct defects of the lateral chest wall and included 10 LD, 6 PM and 2 serratus anterior (SA) muscles, with associated advancement of the diaphragm in two cases. Two patients required rectus abdominis myocutaneous flaps because other local muscles had been previously excised and irradiated. One (3%) hospital death occurred as a result of bacterial pneumonia. Two septic local complications after total sternectomy required removal of the prosthetic material but both myocutaneous flaps were preserved. With a median follow-up of 38 months, overall 2- and 5-year survival rates were 66% and 50%, respectively. Local recurrence developed in four cases (12.5%). Chest wall stabilization is essential after resection of large anterior and lateral PMCWTs; soft tissue coverage is possible using well vascularized muscle or myocutaneous flaps.

Original languageEnglish
Pages (from-to)351-357
Number of pages7
JournalEuropean Journal of Cardio-thoracic Surgery
Volume8
Issue number7
Publication statusPublished - 1994

Keywords

  • Chest wall
  • Muscle flaps
  • Primary tumors
  • Reconstruction
  • Resection

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Surgery

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  • Cite this

    Chapelier, A., Macchiarini, P., Rietjens, M., Lenot, B., Margulis, A., Petit, J. Y., & Dartevelle, P. (1994). Chest wall reconstruction following resection of large primary malignant tumors. European Journal of Cardio-thoracic Surgery, 8(7), 351-357.