Functional assessment of chest wall integrity after methylmethacrylate reconstruction

Background. All patients with extensive resection of the anterolateral ches t wall and the sternum followed by reconstruction with methylmethacrylate s ubstitutes were assessed prospectively 6 months after the operation to deli neate chest wall integrity with pulmonary function and cine-magnetic resona nce imaging. Methods. Twenty-six patients underwent chest wall reconstruction by use of methylmethacrylate between 1994 and 1998 due to primary tumors in 35%, meta stases in 27%, T3 lung cancer in 19%, and debridement for radionecrosis and osteomyelitis in 19% of patients. Three to eight ribs were resected and ad ditional sternum resection was performed in 39% of patients. Results. There was no 30-day mortality. All patients were extubated after t he operation without need for reintubation. Prosthesis dislocation occurred in 1 patient and infection in 2 patients during follow-up. Nineteen patien ts (73%) suffered no restrictions of daily activities. Clinical examination revealed normal shoulder girdle function in 77% of patients. There was no significant difference between preoperative and postoperative FEV1 (forced expiratory volume in 1 second) measurements in patients with lobectomy or w edge resections. Cinemagnetic resonance imaging revealed concordant chest w all movements during respiration in 92% of patients without paradoxical mov ements or implant dislocations being observed. Conclusions. Large defects of the anterolateral chest wall and sternum can be reconstructed efficiently with methylmethacrylate substitutes with minim al morbidity and excellent cosmetic and functional outcome.