Reconstruction with fascia lata after extensive chest wall resection: Results

Lorenza Puviani, Nicola Fazio, Luca Boriani, Pietro Ruggieri, Pier Maria Fornasari, Antonio Briccoli

Research output: Contribution to journalArticle

Abstract

OBJECTIVES: Following extensive chest wall resection, the reconstruction technique should fulfill two opposing functional requirements: adequate rigidity and flexibility of the chest wall during the breathing phases. Reconstruction with fascia lata enables a balance between these two parameters, thus favouring the patients' respiratory dynamics and producing low morbidity and good functional results. METHODS: Sixty patients underwent chest wall reconstruction using fascia lata alone or in combination with titanium plates between 2006 and 2011, due to primary tumours in 28 patients, metastases in 23 and local recurrences in 9. The mean area of resected tissue was 107.7 cm2, distributed among the anterior, anterolateral, lateral and posterior zones. One-to-eight ribs were resected, and additional sternum resection was performed in 75% of patients. Forced expiratory volume in 1 s (FEV1) and forced vital capacity (FVC) were evaluated in 33 patients. RESULTS: 46.6% of patients underwent reconstruction with fascia lata alone, 1.6% with fascia lata, DualMesh® and titanium plates and 51.6% with fascia lata and titanium plates. There was no 30-day mortality. All patients were extubated after the operation with no need for reintubation. Five patients had postoperative complications: 2 wound dehiscences, 2 haematomas and 1 seroma. There were no significant differences between preoperative and postoperative FEV1 and FVC measurements in patients with or without lobectomy and wedge resections. CONCLUSIONS: Chest wall reconstruction with fascia lata, alone or in combination with titanium plates, allows the surgeon to perform a dynamic reconstruction without flail chest in extensive exeresis. Risks of infection associated with the use of prosthetic materials are also minimized. In addition, the characteristic flexibility of this tissue makes it a precious tool in paediatric chest wall reconstruction, since fascia lata naturally adapts to the physiological growth of younger bodies, thus reducing the risk of scoliosis and local deformities.

Original languageEnglish
Article numberezs652
Pages (from-to)125-129
Number of pages5
JournalEuropean Journal of Cardio-thoracic Surgery
Volume44
Issue number1
DOIs
Publication statusPublished - Jul 2013

Fingerprint

Fascia Lata
Thoracic Wall
Titanium
Vital Capacity
Forced Expiratory Volume
Flail Chest
Seroma
Sternum
Scoliosis
Ribs
Hematoma
Respiration
Pediatrics
Neoplasm Metastasis
Morbidity
Recurrence

Keywords

  • Chest wall reconstruction
  • Chest wall resection
  • Chest wall tumour
  • Fascia lata
  • Pulmonary function

ASJC Scopus subject areas

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

Cite this

Puviani, L., Fazio, N., Boriani, L., Ruggieri, P., Fornasari, P. M., & Briccoli, A. (2013). Reconstruction with fascia lata after extensive chest wall resection: Results. European Journal of Cardio-thoracic Surgery, 44(1), 125-129. [ezs652]. https://doi.org/10.1093/ejcts/ezs652

Reconstruction with fascia lata after extensive chest wall resection : Results. / Puviani, Lorenza; Fazio, Nicola; Boriani, Luca; Ruggieri, Pietro; Fornasari, Pier Maria; Briccoli, Antonio.

In: European Journal of Cardio-thoracic Surgery, Vol. 44, No. 1, ezs652, 07.2013, p. 125-129.

Research output: Contribution to journalArticle

Puviani, L, Fazio, N, Boriani, L, Ruggieri, P, Fornasari, PM & Briccoli, A 2013, 'Reconstruction with fascia lata after extensive chest wall resection: Results', European Journal of Cardio-thoracic Surgery, vol. 44, no. 1, ezs652, pp. 125-129. https://doi.org/10.1093/ejcts/ezs652
Puviani L, Fazio N, Boriani L, Ruggieri P, Fornasari PM, Briccoli A. Reconstruction with fascia lata after extensive chest wall resection: Results. European Journal of Cardio-thoracic Surgery. 2013 Jul;44(1):125-129. ezs652. https://doi.org/10.1093/ejcts/ezs652
Puviani, Lorenza ; Fazio, Nicola ; Boriani, Luca ; Ruggieri, Pietro ; Fornasari, Pier Maria ; Briccoli, Antonio. / Reconstruction with fascia lata after extensive chest wall resection : Results. In: European Journal of Cardio-thoracic Surgery. 2013 ; Vol. 44, No. 1. pp. 125-129.
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N2 - OBJECTIVES: Following extensive chest wall resection, the reconstruction technique should fulfill two opposing functional requirements: adequate rigidity and flexibility of the chest wall during the breathing phases. Reconstruction with fascia lata enables a balance between these two parameters, thus favouring the patients' respiratory dynamics and producing low morbidity and good functional results. METHODS: Sixty patients underwent chest wall reconstruction using fascia lata alone or in combination with titanium plates between 2006 and 2011, due to primary tumours in 28 patients, metastases in 23 and local recurrences in 9. The mean area of resected tissue was 107.7 cm2, distributed among the anterior, anterolateral, lateral and posterior zones. One-to-eight ribs were resected, and additional sternum resection was performed in 75% of patients. Forced expiratory volume in 1 s (FEV1) and forced vital capacity (FVC) were evaluated in 33 patients. RESULTS: 46.6% of patients underwent reconstruction with fascia lata alone, 1.6% with fascia lata, DualMesh® and titanium plates and 51.6% with fascia lata and titanium plates. There was no 30-day mortality. All patients were extubated after the operation with no need for reintubation. Five patients had postoperative complications: 2 wound dehiscences, 2 haematomas and 1 seroma. There were no significant differences between preoperative and postoperative FEV1 and FVC measurements in patients with or without lobectomy and wedge resections. CONCLUSIONS: Chest wall reconstruction with fascia lata, alone or in combination with titanium plates, allows the surgeon to perform a dynamic reconstruction without flail chest in extensive exeresis. Risks of infection associated with the use of prosthetic materials are also minimized. In addition, the characteristic flexibility of this tissue makes it a precious tool in paediatric chest wall reconstruction, since fascia lata naturally adapts to the physiological growth of younger bodies, thus reducing the risk of scoliosis and local deformities.

AB - OBJECTIVES: Following extensive chest wall resection, the reconstruction technique should fulfill two opposing functional requirements: adequate rigidity and flexibility of the chest wall during the breathing phases. Reconstruction with fascia lata enables a balance between these two parameters, thus favouring the patients' respiratory dynamics and producing low morbidity and good functional results. METHODS: Sixty patients underwent chest wall reconstruction using fascia lata alone or in combination with titanium plates between 2006 and 2011, due to primary tumours in 28 patients, metastases in 23 and local recurrences in 9. The mean area of resected tissue was 107.7 cm2, distributed among the anterior, anterolateral, lateral and posterior zones. One-to-eight ribs were resected, and additional sternum resection was performed in 75% of patients. Forced expiratory volume in 1 s (FEV1) and forced vital capacity (FVC) were evaluated in 33 patients. RESULTS: 46.6% of patients underwent reconstruction with fascia lata alone, 1.6% with fascia lata, DualMesh® and titanium plates and 51.6% with fascia lata and titanium plates. There was no 30-day mortality. All patients were extubated after the operation with no need for reintubation. Five patients had postoperative complications: 2 wound dehiscences, 2 haematomas and 1 seroma. There were no significant differences between preoperative and postoperative FEV1 and FVC measurements in patients with or without lobectomy and wedge resections. CONCLUSIONS: Chest wall reconstruction with fascia lata, alone or in combination with titanium plates, allows the surgeon to perform a dynamic reconstruction without flail chest in extensive exeresis. Risks of infection associated with the use of prosthetic materials are also minimized. In addition, the characteristic flexibility of this tissue makes it a precious tool in paediatric chest wall reconstruction, since fascia lata naturally adapts to the physiological growth of younger bodies, thus reducing the risk of scoliosis and local deformities.

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