Chestwall resection: a new and simple method for stabilization of extendeddefects

Objective: Postresectional chestwall defects can usually be stabilized by r econstructions under tension. Only few extended defects require combined st abilizing methods. The one used mostly is Marlex ((R))-Sandwich, despite so me disadvantages. An alternative method using alloplastic material/metal ba r is presented. Material and methods: Between 1986 and 1999. 189 chestwall resections were performed either for infiltrating bronchogenic carcinoma (T ype I. n = 67), tumors originating from chestwall or bony metastases (Type II. n = 88), or local recurrences and infiltration by breast cancer or sequ elae of its treatment (Type III. n = 34).The standard reconstruction is per formed with non-absorbable alloplastic meshes or patches under some degree of tension. For defects exceeding 250 cm(2), usually Type-II cases. a recon struction under tension is no longer appropriate, Therefore we developed a procedure which we used in six cases. Alloplastic mesh or patch gets suture d in the same way as is done in smaller defects. Then a metal bar (Grob-Sta b ((R)). Ulrich. Herrlingen/Blaustein, Germany) is threaded through the all oplastic material and is fixed at the adjacent ribs by Parham steel bands ( Ethicon. Sommerville, KY, USA). Results: In all cases we achieved excellent stability. All of the patients were extubated on the operating table. Ther e was no morbidity or mortality. In three cases the metal bars were removed after 3, 6 and 16 months postoperatively (dynamization). Conclusion: The n ew procedure is safe., simple and quickly performed. The additional costs a re low ( 160 euro). The patient's comfort is excellent borderline problems as described for Marlex ((R))-Sandwich can be avoided, so that this procedu re can be considered as an alternative to Marlex ((R))-Sandwich. (C) 2001 E lsevier Science B.V. All rights reserved.