Department of Orthopaedics and Trauma, Medical University of Graz, Graz, Austria.
Division of Thoracic and Hyperbaric Surgery, Department of Surgery, Medical University of Graz, Graz, Austria.
Eur J Cardiothorac Surg. 2022 Nov 3;62(6). doi: 10.1093/ejcts/ezac534.
The reconstruction of the chest wall defect after tumour resection presents a challenge. Titanium rib plates were presented as a reconstruction option due to its biocompatibility, flexibility and pliability. The aim of this study was to evaluate the outcome of single-centre cohort treated with chest wall reconstruction after tumour resections, with a focus on the titanium rib plates reconstruction.
We retrospectively reviewed the data of 26 patients who underwent wide resection for malignancies of the chest wall, where reconstruction was performed using polypropylene mesh, porcine dermal collagen mesh with or without titanium rib plates, operated on between 2012 and 2019. Events being associated with the surgery requiring revision were rated as complications.
Most of the patients had primary tumours (n = 19; 73%). A mean of 3.7 ribs (range: 1-7) was resected. Reconstruction was performed with titanium rib plates (13 patients, 50%), of these 11 were performed with additional mesh grafts. The remaining 13 patients (50%) underwent reconstruction with mesh grafts only. Fourteen patients (54%) developed a complication requiring surgical revision, after a median of 5.5 months. The most common complication was wound healing deficit (n = 4), plate fracture (n = 2), mesh rupture (n = 2), infection (n = 2) and local recurrence (n = 2). The only factor being associated with the development of complications was the usage of a plate (P = 0.015), irrespective of defect size (P = 0.29).
The high complication rate is found when using titanium plates for chest wall reconstruction after tumour resection. A high caution is recommended in choosing the chest wall reconstruction method.
肿瘤切除后胸壁缺损的重建是一个挑战。由于钛肋骨板具有生物相容性、柔韧性和可塑性，因此被提出作为一种重建选择。本研究的目的是评估单一中心队列接受肿瘤切除后胸壁重建的结果，重点是钛肋骨板重建。
我们回顾性分析了 2012 年至 2019 年间接受广泛切除术治疗胸壁恶性肿瘤的 26 例患者的数据，这些患者接受了聚丙稀网片、猪真皮胶原网片联合或不联合钛肋骨板的重建。需要再次手术修复的手术相关事件被评定为并发症。
大多数患者均为原发性肿瘤（n=19；73%）。平均切除 3.7 根肋骨（范围：1-7 根）。使用钛肋骨板进行重建（13 例，50%），其中 11 例还联合了网片移植物。其余 13 例（50%）仅进行了网片移植物重建。14 例（54%）患者在中位时间 5.5 个月后发生了需要手术修复的并发症。最常见的并发症是伤口愈合不良（n=4）、钢板骨折（n=2）、网片破裂（n=2）、感染（n=2）和局部复发（n=2）。唯一与并发症发生相关的因素是使用钢板（P=0.015），而与缺陷大小无关（P=0.29）。
肿瘤切除后使用钛板进行胸壁重建的并发症发生率较高。在选择胸壁重建方法时应高度谨慎。
