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Ann Thorac Surg 2002;73:1720-1726
© 2002 The Society of Thoracic Surgeons


Original article: general thoracic

Chest wall resections and reconstruction: a 25-year experience

Kamal A. Mansour, MD*a, Vinod H. Thourani, MDa, Albert Losken, MDb, James G. Reeves, BSa, Joseph I. Miller, Jr, MDa, Grant W. Carlson, MDb, Glyn E. Jones, MDb

a Joseph B. Whitehead Department of Surgery, Divisions of Cardiothoracic Surgery, Emory University School of Medicine, Atlanta, Georgia USA
b Joseph B. Whitehead Department of Surgery, division of Plastic and Reconstructive Surgery, Emory University School of Medicine, Atlanta, Georgia USA

* Address reprint requests to Dr Mansour, 1365 Clifton Rd, The Emory Clinic, Atlanta, GA 30322 USA
e-mail: kamalmansour{at}emoryheathcare.org

Presented at the Forty-eighth Annual Meeting of the Southern Thoracic Surgical Association, San Antonio, TX, Nov 8–10, 2001.

Background. Chest wall defects continue to present a complicated treatment scenario for thoracic and reconstructive surgeons. The purpose of this study is to report our 25-year experience with chest wall resections and reconstructions.

Methods. A retrospective review of 200 patients who had chest wall resections from 1975 to 2000 was performed.

Results. Patient demographics included tobacco abuse, hypertension, diabetes mellitus, alcohol abuse, coronary artery disease, chronic obstructive pulmonary disease, and human immunodeficiency virus. Surgical indications included lung cancer, breast cancer, chest wall tumors, and severe pectus deformities. Twenty-nine patients had radiation necrosis and 31 patients had lung or chest wall infections. The mean number of ribs resected was 4 ± 2 ribs. Fifty-six patients underwent sternal resections. In addition 14 patients underwent forequarter amputations. Immediate closure was performed in 195 patients whereas delayed closure was performed in 5 patients. Primary repair without the use of reconstructive techniques was possible in 43 patients. Synthetic chest wall reconstruction was performed using Prolene mesh, Marlex mesh, methyl methacrylate sandwich, Vicryl mesh, and polytetrafluoroethylene. Flaps utilized for soft tissue coverage were free flap (17 patients) and pedicled flap (96 patients). Mean postoperative length of stay was 14 ± 14 days. Mean intensive care unit stay was 5 ± 9 days. In-hospital and 30-day survival was 93%.

Conclusions. Chest wall resection with reconstruction utilizing synthetic mesh or local muscle flaps can be performed as a safe, effective one-stage surgical procedure for a variety of major chest wall defects.




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