Postoperative local morbidity and the use of vacuum-assisted closure after complex chest wall reconstructions with new and conventional materials

Research output: Contribution to journalArticle

11 Citations (Scopus)

Abstract

Background New materials (NM) such as titanium plates, cryopreserved grafts, and acellular collagen matrices are being increasingly used for chest wall reconstruction as a result of improved incorporation while maintaining structural stability and reduced need for removal from infected areas. Direct comparisons between NM and conventional materials (CM) in terms of local morbidity and need for prosthesis removal are lacking. Methods Between January 2005 and July 2013, 109 procedures were performed to remove chest wall tumors in 86 patients. Of these, 32 underwent complex chest wall reconstructions owing to either recurrence, defect extension (greater than 3 ribs or >100 cm 2) or local conditions (ie, previous irradiation or infection). New materials and CM (ie, polytetrafluoroethylene and methyl methacrylate) were used in 17 (53%) and 15 (47%) patients, respectively. Of the 32 patients included in the high complexity group, 23 patients did not exhibit any postoperative complications (72%). However, 9 patients (28%) underwent both a first and a second reoperation after a median interval of 4 months from the first procedure (range, 7 days to 60 months). Vacuum-assisted closure (VAC) was instituted in all patients as a means to control sepsis and facilitate space obliteration with healthy tissue. Results In 7 patients the reason for reintervention was local wound complications. In 4 of 7 patients, the prosthesis had to be removed (3 CM and 1 NM, 4.6% of the whole series; 12.5% in the high complexity group, 5.9% for NM and 20% for CM). The median time to complete chest wall healing after VAC in patients with local sepsis was 14 months (range, 5 to 60 months). All patients are currently alive and well except for 1 who died 11 months after complete chest wall healing as a result of dissemination of metastatic chondrosarcoma. At univariate analysis, predictors of overall and grade 2 or less morbidity according to the Common Terminology Criteria for Adverse Events version 4.0 were first (p = 0.038) and second (p = 0.015) redo operations. Conversely, patients with a body mass index of less than 25 kg/m2 (p = 0.049) undergoing one (p = 0.032) or two reconstructions (p = 0.00047) with combined materials (p = 0.00029) were more likely to experience local wound complications and require VAC. On multiple regression analysis, redo operations (first, p = 0.032; second, p = 0.00047) and the use of combined (synthetic and biologic) materials (p = 0.0029) were confirmed to be related to an increased incidence of wound complications. Conclusions Multiple redo operations after complex chest wall reconstruction performed with a combination of NM and CM may be associated with an increased incidence of local wound complications. Nevertheless, in these cases, the use of NM and VAC yielded a low rate (5.8% versus 20% with CM) of prosthesis removal while achieving complete wound healing.

Original languageEnglish
Pages (from-to)291-296
Number of pages6
JournalAnnals of Thoracic Surgery
Volume98
Issue number1
DOIs
Publication statusPublished - 2014

Fingerprint

Negative-Pressure Wound Therapy
Thoracic Wall
Morbidity
Prostheses and Implants
Wounds and Injuries
Sepsis
Chondrosarcoma
Methacrylates
Incidence
Polytetrafluoroethylene
Ribs
Titanium
Reoperation
Terminology
Wound Healing
Body Mass Index
Collagen

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Surgery
  • Pulmonary and Respiratory Medicine

Cite this

@article{da65654a425046b4b4d0fb84ab69a09a,
title = "Postoperative local morbidity and the use of vacuum-assisted closure after complex chest wall reconstructions with new and conventional materials",
abstract = "Background New materials (NM) such as titanium plates, cryopreserved grafts, and acellular collagen matrices are being increasingly used for chest wall reconstruction as a result of improved incorporation while maintaining structural stability and reduced need for removal from infected areas. Direct comparisons between NM and conventional materials (CM) in terms of local morbidity and need for prosthesis removal are lacking. Methods Between January 2005 and July 2013, 109 procedures were performed to remove chest wall tumors in 86 patients. Of these, 32 underwent complex chest wall reconstructions owing to either recurrence, defect extension (greater than 3 ribs or >100 cm 2) or local conditions (ie, previous irradiation or infection). New materials and CM (ie, polytetrafluoroethylene and methyl methacrylate) were used in 17 (53{\%}) and 15 (47{\%}) patients, respectively. Of the 32 patients included in the high complexity group, 23 patients did not exhibit any postoperative complications (72{\%}). However, 9 patients (28{\%}) underwent both a first and a second reoperation after a median interval of 4 months from the first procedure (range, 7 days to 60 months). Vacuum-assisted closure (VAC) was instituted in all patients as a means to control sepsis and facilitate space obliteration with healthy tissue. Results In 7 patients the reason for reintervention was local wound complications. In 4 of 7 patients, the prosthesis had to be removed (3 CM and 1 NM, 4.6{\%} of the whole series; 12.5{\%} in the high complexity group, 5.9{\%} for NM and 20{\%} for CM). The median time to complete chest wall healing after VAC in patients with local sepsis was 14 months (range, 5 to 60 months). All patients are currently alive and well except for 1 who died 11 months after complete chest wall healing as a result of dissemination of metastatic chondrosarcoma. At univariate analysis, predictors of overall and grade 2 or less morbidity according to the Common Terminology Criteria for Adverse Events version 4.0 were first (p = 0.038) and second (p = 0.015) redo operations. Conversely, patients with a body mass index of less than 25 kg/m2 (p = 0.049) undergoing one (p = 0.032) or two reconstructions (p = 0.00047) with combined materials (p = 0.00029) were more likely to experience local wound complications and require VAC. On multiple regression analysis, redo operations (first, p = 0.032; second, p = 0.00047) and the use of combined (synthetic and biologic) materials (p = 0.0029) were confirmed to be related to an increased incidence of wound complications. Conclusions Multiple redo operations after complex chest wall reconstruction performed with a combination of NM and CM may be associated with an increased incidence of local wound complications. Nevertheless, in these cases, the use of NM and VAC yielded a low rate (5.8{\%} versus 20{\%} with CM) of prosthesis removal while achieving complete wound healing.",
author = "Gaetano Rocco and Nicola Martucci and {La Rocca}, Antonello and {La Manna}, Carmine and {De Luca}, Giuseppe and Flavio Fazioli and Stefano Mori",
year = "2014",
doi = "10.1016/j.athoracsur.2014.04.022",
language = "English",
volume = "98",
pages = "291--296",
journal = "Annals of Thoracic Surgery",
issn = "0003-4975",
publisher = "The Society of Thoracic Surgeons. Published by Elsevier Inc",
number = "1",

}

TY - JOUR

T1 - Postoperative local morbidity and the use of vacuum-assisted closure after complex chest wall reconstructions with new and conventional materials

AU - Rocco, Gaetano

AU - Martucci, Nicola

AU - La Rocca, Antonello

AU - La Manna, Carmine

AU - De Luca, Giuseppe

AU - Fazioli, Flavio

AU - Mori, Stefano

PY - 2014

Y1 - 2014

N2 - Background New materials (NM) such as titanium plates, cryopreserved grafts, and acellular collagen matrices are being increasingly used for chest wall reconstruction as a result of improved incorporation while maintaining structural stability and reduced need for removal from infected areas. Direct comparisons between NM and conventional materials (CM) in terms of local morbidity and need for prosthesis removal are lacking. Methods Between January 2005 and July 2013, 109 procedures were performed to remove chest wall tumors in 86 patients. Of these, 32 underwent complex chest wall reconstructions owing to either recurrence, defect extension (greater than 3 ribs or >100 cm 2) or local conditions (ie, previous irradiation or infection). New materials and CM (ie, polytetrafluoroethylene and methyl methacrylate) were used in 17 (53%) and 15 (47%) patients, respectively. Of the 32 patients included in the high complexity group, 23 patients did not exhibit any postoperative complications (72%). However, 9 patients (28%) underwent both a first and a second reoperation after a median interval of 4 months from the first procedure (range, 7 days to 60 months). Vacuum-assisted closure (VAC) was instituted in all patients as a means to control sepsis and facilitate space obliteration with healthy tissue. Results In 7 patients the reason for reintervention was local wound complications. In 4 of 7 patients, the prosthesis had to be removed (3 CM and 1 NM, 4.6% of the whole series; 12.5% in the high complexity group, 5.9% for NM and 20% for CM). The median time to complete chest wall healing after VAC in patients with local sepsis was 14 months (range, 5 to 60 months). All patients are currently alive and well except for 1 who died 11 months after complete chest wall healing as a result of dissemination of metastatic chondrosarcoma. At univariate analysis, predictors of overall and grade 2 or less morbidity according to the Common Terminology Criteria for Adverse Events version 4.0 were first (p = 0.038) and second (p = 0.015) redo operations. Conversely, patients with a body mass index of less than 25 kg/m2 (p = 0.049) undergoing one (p = 0.032) or two reconstructions (p = 0.00047) with combined materials (p = 0.00029) were more likely to experience local wound complications and require VAC. On multiple regression analysis, redo operations (first, p = 0.032; second, p = 0.00047) and the use of combined (synthetic and biologic) materials (p = 0.0029) were confirmed to be related to an increased incidence of wound complications. Conclusions Multiple redo operations after complex chest wall reconstruction performed with a combination of NM and CM may be associated with an increased incidence of local wound complications. Nevertheless, in these cases, the use of NM and VAC yielded a low rate (5.8% versus 20% with CM) of prosthesis removal while achieving complete wound healing.

AB - Background New materials (NM) such as titanium plates, cryopreserved grafts, and acellular collagen matrices are being increasingly used for chest wall reconstruction as a result of improved incorporation while maintaining structural stability and reduced need for removal from infected areas. Direct comparisons between NM and conventional materials (CM) in terms of local morbidity and need for prosthesis removal are lacking. Methods Between January 2005 and July 2013, 109 procedures were performed to remove chest wall tumors in 86 patients. Of these, 32 underwent complex chest wall reconstructions owing to either recurrence, defect extension (greater than 3 ribs or >100 cm 2) or local conditions (ie, previous irradiation or infection). New materials and CM (ie, polytetrafluoroethylene and methyl methacrylate) were used in 17 (53%) and 15 (47%) patients, respectively. Of the 32 patients included in the high complexity group, 23 patients did not exhibit any postoperative complications (72%). However, 9 patients (28%) underwent both a first and a second reoperation after a median interval of 4 months from the first procedure (range, 7 days to 60 months). Vacuum-assisted closure (VAC) was instituted in all patients as a means to control sepsis and facilitate space obliteration with healthy tissue. Results In 7 patients the reason for reintervention was local wound complications. In 4 of 7 patients, the prosthesis had to be removed (3 CM and 1 NM, 4.6% of the whole series; 12.5% in the high complexity group, 5.9% for NM and 20% for CM). The median time to complete chest wall healing after VAC in patients with local sepsis was 14 months (range, 5 to 60 months). All patients are currently alive and well except for 1 who died 11 months after complete chest wall healing as a result of dissemination of metastatic chondrosarcoma. At univariate analysis, predictors of overall and grade 2 or less morbidity according to the Common Terminology Criteria for Adverse Events version 4.0 were first (p = 0.038) and second (p = 0.015) redo operations. Conversely, patients with a body mass index of less than 25 kg/m2 (p = 0.049) undergoing one (p = 0.032) or two reconstructions (p = 0.00047) with combined materials (p = 0.00029) were more likely to experience local wound complications and require VAC. On multiple regression analysis, redo operations (first, p = 0.032; second, p = 0.00047) and the use of combined (synthetic and biologic) materials (p = 0.0029) were confirmed to be related to an increased incidence of wound complications. Conclusions Multiple redo operations after complex chest wall reconstruction performed with a combination of NM and CM may be associated with an increased incidence of local wound complications. Nevertheless, in these cases, the use of NM and VAC yielded a low rate (5.8% versus 20% with CM) of prosthesis removal while achieving complete wound healing.

UR - http://www.scopus.com/inward/record.url?scp=84903897918&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=84903897918&partnerID=8YFLogxK

U2 - 10.1016/j.athoracsur.2014.04.022

DO - 10.1016/j.athoracsur.2014.04.022

M3 - Article

VL - 98

SP - 291

EP - 296

JO - Annals of Thoracic Surgery

JF - Annals of Thoracic Surgery

SN - 0003-4975

IS - 1

ER -