Prosthetic Reconstruction of the Chest Wall
Section snippets
Available materials and techniques
The use of metal prostheses was first reported by a French surgeon Gangolphe1 in 1909. In the 1940s, better-tolerated and easier-to-use materials emerged, such as tantalum plates,2 but the modern era of chest wall reconstruction arose with the advent of plastic components.3 In 1960, Graham and colleagues4 provided a comprehensive historical perspective of these early steps. Half a century later, a multitude of materials exists, including synthetic meshes, bone substitutes, osteosynthesis
Results
A review of the literature on prosthetic chest wall reconstruction is hampered by several limitations, the strongest of which is the absence of prospective trials comparing the different techniques and materials because of the low surgical volume, even in specialized centers. Furthermore, most single-institution experiences encompass multiple decades, and therefore do not optimally show the continuous refinements in patient selection, surgical technique, reconstructive materials, and
Discussion
Posterior and apical chest wall defects generally do not require prosthetic reconstruction for functional reasons because of the natural parietal suspension provided by the sternum, scapula, clavicula, and attached wide muscles of the thorax. However, defects that extend down to 5th and 6th ribs may cause the impaction of the tip of the scapula, which is a source of discomfort. In those patients, bridging the defect through suturing a synthetic mesh under tension is adequate. Small lateral or
Summary
The choice of techniques and materials for chest wall reconstruction depends on the size and position of the defect, the surgeon’s proper experience, and some economical considerations. Meanwhile, the availability of multiple, possibly combined, more adapted, and better-tolerated prostheses have pushed past the limits of resection to those involving soft tissue coverage, an issue that is addressed in another article.
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Results of chest wall resection and reconstruction with and without rigid prosthesis
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2023, Journal of Thoracic Disease