SESSION TITLE: Surgery Case Report Posters II
SESSION TYPE: Case Report Poster
PRESENTED ON: Sunday, March 23, 2014 at 01:15 PM - 02:15 PM
INTRODUCTION: Radical chest wall tumor resections result in large chest wall defects that expose intrathoracic organs to injury, risk lung herniation or scapular entrapment, and create flail chest segments that negatively impact respiration.
CASE PRESENTATION: A 68-year-old woman with 15-cm right posterolateral chest wall rhabdomyosarcoma. After doxorubicin chemotherapy, radical tumor debulking was recommended prior to further chemotherapy. She underwent radical right posterolateral chest wall resection, including ribs 4-9, en bloc resection of the right scapular tip and involved portions of latissimus, serratus, and rhomboid muscles. Resection of ribs 4-9 required disarticulation at their costovertebral joints. Chest wall reconstruction was performed by fixation of 6 Synthes titanium rib plates anterolaterally to the transected ribs and posteromedially to corresponding transverse processes. Bioabsorbable mesh was sewn to the chest wall defect edges to cover the titanium plates. Right latissimus myocutaneous flap was rotated to cover the chest wall soft tissue defect, and remaining exposed area chest wall inferiorly was covered by split-thickness skin graft (STSG) and WoundVAC. The patient was extubated immediately postoperatively, but required BiPAP until perioperative pain was controlled. She required return to OR on postoperative day (POD) #5 for video-assisted thoracoscopic evacuation of loculated right pleural effusion, doxycycline pleurodesis, revision of the myocutaneous flap posterior edge, evacuation of subcutaneous right flank hematoma, and revision of the STSG. She was extubated on POD#3, after which she became ambulatory with physical therapy. Her chest tubes and all but one submuscular drains were removed, and she was discharged from hospital to a rehabilitation facility on POD#18 from her initial chest wall resection and reconstruction.
DISCUSSION: Reconstruction of chest wall defects with titanium rib plates and bioabsorbable mesh results in rigid support of extrathoracic musculature but allows ribs to maintain individual “bucket handle” motion compared to reconstruction with non-rigid mesh alone or with rigid but en masse reconstruction with methylmethacrylate.
CONCLUSIONS: Reconstruction of chest wall defects with titanium rib plates and bioabsorbable mesh maintains the proper chest wall mechanics required for normal respiration.
Reference #1: None.
DISCLOSURE: The following authors have nothing to disclose: Eric Toloza, Christian Sobky, Jose Pimiento, Joseph Garrett, Effie Pappas-Politis, Jeremiah Deneve, David Kim, David Plank, Paul Smith, Ricardo Gonzalez
Use of the Synthes MatrixRib Fixation System is not yet approved for fixation onto the thoracic spine.