A variety of materials and techniques have been used to repair the defect when required. These include the transfer of autogenous material such as muscle flaps and/or bone grafts, sowing in relatively flexible mesh (ie, Prolene [Ethicon; Sommerville, NJ], Marlex [CR Bard; Murray Hill, NJ], Vicryl [Ethicon], or Gortex [Gore and Associates; Flagstaff, AZ]), or the implantation of rigid struts or composite materials such as methyl methacrylate sandwiched between two pieces of Marlex mesh.1,7–
When defects are relatively small, such as those that are less than the span of three contiguous ribs in width, repair with taut single-layered or double-layered mesh will result in acceptable stability. In patients who are at risk of infection (for example, after resection in the setting of postobstructive changes), repair with a bioabsorbable material such as a Vicryl mesh may be a safer alternative. The methyl methacrylate/Marlex mesh sandwich repair offers a number of potential advantages if a large portion of the chest wall needs to be resected. It can be molded to assume the curvature of the chest wall, and it offers rigidity, which may confer some benefit in terms of respiratory function8
and protection of the intrathoracic structures. Complications of this type of repair are rare, and include instability of the graft and infection requiring removal. Despite its relatively higher costs of use, the simplicity and ease of using the 2-mm thick polytetrafluoroethelene patch appears to have gained wider popularity over the last few years.