Microsurgical chest wall reconstruction after oncologic resections.
Ontology highlight
ABSTRACT:
SUBMITTER: Sauerbier M
PROVIDER: S-EPMC3140233 | biostudies-other | 2011 Feb
REPOSITORIES: biostudies-other
Similar Datasets
Project description:Computer modeling and 3D printing has found wide-scale applicability in pre- and intraoperative meticulous planning of surgery. Dr. Harsh Singh from Christchurch Hospital, New Zealand, discusses its current and future role in chest wall reconstruction.
| S-EPMC7525701 | biostudies-literature
Project description:The chest wall functions as a protective cage around the vital organs of the body, and significant disruption of its structure can have dire respiratory and circulatory consequences. The past several decades have seen a marked improvement in the management and reconstruction of complex chest wall defects. Widespread acceptance of muscle and musculocutaneous flaps such as the latissimus dorsi, pectoralis major, serratus anterior, and rectus abdominis has led to a sharp decrease in infections and mortality. Successful reconstructions are dependent upon a detailed knowledge of the functional anatomy and blood supply of the chest and the underlying pathophysiology of a particular disease process. This article will provide an overview of key principles and evidence-based approaches to chest wall reconstruction.
| S-EPMC3140236 | biostudies-other
Project description:Chest wall tumors are a relatively uncommon disease in clinical practice. Most of the published studies about chest wall tumors are usually single-center retrospective studies, involving few patients. Therefore, evidences regarding clinical conclusions about chest wall tumors are lacking, and some controversial issues have still to be agreed upon. In January 2019, 73 experts in thoracic surgery, plastic surgery, science, and engineering jointly released the Chinese Expert Consensus on Chest Wall Tumor Resection and Chest Wall Reconstruction (2018 edition). After that, numerous experts put forward new perspectives on some academic issues in this version of the consensus, pointing out the necessity to further discuss the points of contention. Thus, we conducted a survey through the administration of a questionnaire among 85 experts in the world. Consensus has been reached on some major points as follows. (I) Wide excision should be performed for desmoid tumor (DT) of chest wall. After excluding the distant metastasis by multi-disciplinary team, solitary sternal plasmacytoma can be treated with extensive resection and adjuvant radiotherapy. (II) Wide excision with above 2 cm margin distance should be attempted to obtain R0 resection margin for chest wall tumor unless the tumor involves vital organs or structures, including the great vessels, heart, trachea, joints, and spine. (III) For patients with chest wall tumors undergoing unplanned excision (UE) for the first time, it is necessary to carry out wide excision as soon as possible within 1-3 months following the previous surgery. (IV) Current Tumor Node Metastasis staging criteria (American Joint Committee on Cancer) of bone tumor and soft tissue sarcoma are not suitable for chest wall sarcomas. (V) It is necessary to use rigid implants for chest wall reconstruction once the maximum diameter of the chest wall defect exceeds 5 cm in adults and adolescents. (VI) For non-small cell lung cancer (NSCLC) invading the chest wall, wide excision with neoadjuvant and/or adjuvant therapy are recommended for patients with stage T3-4N0-1M0. As clear guidelines are lacking, these consensus statements on controversial issues on chest wall tumors and resection could possibly serve as further guidance in clinical practice during the upcoming years.
| S-EPMC8674598 | biostudies-literature
Project description:Background and objectiveThe development of early screening for lung cancer has led to improved overall survival in patients with non-small cell lung cancer (NSCLC). However, the management of NSCLC patients with resectable and potentially resectable chest wall invasion (CWI) requires attention. The purpose of this review is to summarize the role of surgery (chest wall resections) in NSCLC patients with CWI.MethodsA literature search and review from three databases (PubMed, Embase, and ScienceDirect) comprised the last 39 years. This review was focused on the treatment of NSCLC patients with CWI, mainly including the preoperative evaluation, principles of treatment and strategic decision-making, surgical complications, and prognostic factors.Key content and findingsThrough the collection of relevant literature on NSCLC that invades the chest wall, this narrative review describes the actual role in clinical practice and future developments of chest wall resections. Preoperative treatment requires the multidisciplinary team (MDT) team to conduct accurate clinical staging of the patient and pay attention to the patient's lymph node status and rib invasion status. The successful implementation of chest wall resection and possible chest wall reconstruction requires refined individualized treatment based on the patient's clinical characteristics, supplemented by possible postoperative systemic treatment.ConclusionsSurgery plays an important role in treating NSCLC patients with CWI, and a collaborative, experienced MDT is an essential component of the successful treatment of CWI with lung cancer. In the future, more high-quality clinical research is needed to focus on CWI patients so that patients can receive more effective treatment options and better clinical prognosis.
| S-EPMC11320248 | biostudies-literature
Project description:The omentum, external oblique musculocutaneous, and thoracoepigastric flaps are uncommonly used for chest wall reconstruction. Nevertheless, awareness and knowledge of these flaps is essential for reconstructive surgeons because they fill specific niche indications or serve as lifeboats when workhorse flaps are unavailable. The current report describes the anatomic basis, technical aspects of flap elevation, and indications for these unusual flaps.
| S-EPMC3140228 | biostudies-other
Project description:The deep inferior epigastric perforator (DIEP) flap has become the free flap of choice for autologous breast reconstruction. However, anastomoses of DIEP pedicles to internal mammary vessels in the chest wall are difficult due to restricted access and the depth of the vessels. Successful performance of such demanding procedures necessitates advanced requirements for microsurgical training models. The current chicken thigh model has been used to acquire microsurgical skills, allowing early learning curve trainees to practice repeatedly in inconsequential environments. Despite the increasing use of this model for training purposes, the resemblance to a clinical environment is tenuous. Such models should include anastomosis practice within the depth where the recipient vessels are located. To address this, we developed a three-dimensional (3D) printed chest wall as an addition to the current chicken thigh model, which reliably mimics the complexity of the anastomosis performed during DIEP breast reconstruction. This form of rapid prototyping facilitates a newfound ability for early learning curve trainees to exercise end-to-end anastomoses on vessels located with variable depths. Our enhancement of the current chicken thigh model is simple, cost-effective and offers a significantly more realistic resemblance to a clinical situation.
| S-EPMC8440024 | biostudies-literature
Project description:Background and objectivePrimary and secondary chest wall tumors (bone, breast, and soft tissue), congenital defects, and chest wall osteoradionecrosis often require extensive full-thickness local excisions to guarantee safe oncological margins (in cases of tumors) and complex reconstruction to provide stabilization and good biomechanical results avoiding postoperative respiratory failure. Thus, a personalized approach is required when dealing with chest wall defects, and reconstruction is planned. This review summarizes failed chest wall reconstruction procedures, identifies causes of failure, and highlights principles for complex chest wall reconstruction post-failure.MethodsWe performed a narrative review of the literature on PubMed, Scopus, ScienceDirect, and Google Scholar, including all the relevant studies published from 1970.Key content and findingsThe available experiences in literature are only anecdotic and no current guidelines or rules exist on this topic, also given to its rarity. Proper pre-surgical planning and a multidisciplinary team (MDT) discussion are crucial for complex cases such as infections and radiation-induced chest ulcers after previous surgical treatment. Procedures should eventually include thoracic wall debridement, necrotic tissue excision, pulse-jet lavage, prosthesis removal, and vacuum assisted closure (VAC) therapy as a bridge for chest wall re-reconstruction. Sternotomy wounds require wire and prosthesis removal, and the use of meshes or bone allografts. This review aims to summarize experiences and highlight surgical and oncologic principles for complex chest wall reconstruction after failure.ConclusionsThis review summarizes literature experiences to identify common key points for chest wall reconstruction after failure and to give some advice to surgeons managing this rare, challenging surgery.
| S-EPMC11320226 | biostudies-literature
Project description:Chest wall and mediastinal wounds may be life-threatening. Although modern reconstruction methods with various muscle flaps have reduced morbidity and mortality, chest wall reconstruction presents unique challenges. Major categories of adverse outcomes include (1) persistent infection; (2) interference with respiratory mechanics; (3) functional deficits of the shoulder; and (4) hernias. Persistent infection may be resolved by providing coverage via muscle or omental flap, performing thorough debridement, filling the "dead space" with adequate volume, buttressing repair of visceral fistulae, and covering exposed prosthetic material with vascularized flaps. Potential deficits in respiratory mechanics and shoulder function may be avoided by stabilizing the chest wall skeleton and decreasing donor muscle functional loss. Hernias may be minimized by maintaining visceral "right of domain" to the chest and abdominal cavities. Complex reconstructive cases represent an intricate interplay of physiology, structural protection, and aesthetic considerations and require integration of several management principles.
| S-EPMC3140240 | biostudies-other
Project description: Not available
| S-EPMC8350807 | biostudies-literature
Project description:Chest wall tumours are heterogeneous neoplasms, either primary or metastatic, with a malignancy rate of 50%. Surgical resection is one of the mainstays of the treatment, however, chest wall resections can be particularly challenging depending onto the resection size, site and patient habitus. The surgical strategy should be carefully analysed preoperatively, keeping in mind the need of an oncological radical resection (R0) in accordance to the reconstruction principles elicited by le Roux and Sherma since 1983, which include restoring the chest wall rigidity, preserving pulmonary mechanics, protect the intrathoracic organs, avoiding paradox movements of the chest cavity and, possibly, to reduce the thoracic deformity. In this context, we herewith report our surgical reconstruction technique following an anterior chest wall resection and sternal body wedge for a primary chest wall tumour (chondrosarcoma).
| S-EPMC6995822 | biostudies-literature