Postoperative transverse sternal nonunion with a chest wall defect managed by a tibial locking plate and a Gore-Tex dual mesh membrane: a case report

Background Transverse sternal nonunion is a rare but disabling complication of chest trauma or a transverse sternotomy. Fixation methods, mainly used to manage the more common longitudinal sternal nonunion, often fail, leaving the surgical treatment of transverse nonunion to be a challenge. Case presentation We present a case of a highly-disabling, postoperative chest wall defect resulting from transverse sternal nonunion after a transverse thoracosternotomy (clamshell incision) and a concomitant rib resection. Following unsuccessful surgical attempts, the sternal nonunion was fixed with a tibial locking plate and bone grafted, while the post-rib resection chest defect was reconstructed with a Gore-Tex dual mesh membrane. Adequate chest stability was achieved, enabling complete healing of the sternal nonunion and the patient’s complete recovery. Conclusion We believe it is important to address both in the rare case of combined postoperative transverse sternal nonunion and the chest wall defect after rib resection. A good outcome was achieved in our patient by fixing the nonunion with an appropriately sized and shaped locking plate with bone grafting and covering the chest defect with a dual mesh membrane.

Pedicled Latissimus Dorsi Kiss Flap for the Reconstruction of Large Chest Wall Defect After Mastectomy

To discover the utility of pedicled latissimus dorsi kiss flap for the reconstruction of chest wall defect after mastectomy. This study was a systemic analysis of 12 female patients with breast tumors who were treated at Affiliated Hospital of Guangdong Medical University from January 2018 to December 2019. Among them, three patients had malignant lobular breast tumors, and nine patients had locally advanced breast cancer. After extensive resection of the primary tumor, the chest wall skin, and soft tissue, a large defect was left in the chest wall of each patient. Based on the design and structure of the kiss flap, two semicircular flaps of equal diameter were designed in the latissimus dorsi region, and their blood supply was retained from the same vascular trunk. Two flaps were transferred to the chest wall through a subcutaneous tunnel, and the incision in the donor area was sutured directly. Finally, two equal semicircle flaps were adjusted to fit the defect and then fixed on the chest wall. Referred to the design of the kiss flap, the area of the latissimus dorsi was increased to cover a larger chest wall defect. We have used this flap to reconstruct chest wall defects on twelve patients. Their age ranged from 24 to 62. The largest defect was 20 × 12 cm, and the smallest defect was 15 × 10 cm in diameter. Postoperative follow-up time was 5–9 months (mean time: 6.2 months): Follow-up observations demonstrated that all the flaps were healed well without edema or extravasation and donor area of all cases was closed well. In addition, no local recurrence or distant metastasis was observed in all patients.

Reconstruction of Complex Chest Wall Defect with Perforator Based Abdominal Flap - A Case Report

Reconstruction of chest wall defect is a complex procedure requiring acute understanding of the vascularity of local flaps used for reconstruction of the defect.

Replacement of an extensive chest wall defect in combination with the elimination of postoperative ventral hernia after combined treatment of breast cancer complicated by osteomyelitis of the sternum and ribs

Plastic replacement of osteochondral defect of the chest wall after surgical treatment of osteomyelitis of the sternum and ribs is a complex and topical issue in surgery. Often, an extensive post-resected defect of the sternum and ribs is combined with instability of the frame of the chest wall and thoracoabdominal hernia, which leads to physiological and socio-psychological maladaptation of the patient. The case of successful replacement of an extensive chest wall defect in combination with a ventral hernia in a patient after combined treatment of breast cancer complicated by osteomyelitis of the sternum and ribs is presented. TiNi- reinforcing rib prostheses and TiNi-mesh were used to create the frame of the chest wall and hernioplasty. 5-year follow-up did not reveal a recurrence of osteomyelitis and ventral hernia, implant displacement and instability of the frame of the chest wall. The method of reconstruction of an extensive thoracoabdominal defect using bioadaptive implants from TiNi is safe and effective in patients at the final stage of surgical treatment of osteomyelitis of the chest wall including in combination with ventral hernia. Thanks to the developed technology, an excellent functional result was achieved.

Postoperative transverse sternal nonunion with a chest wall defect managed by a tibial locking plate and a Gore-Tex dual mesh membrane: a case report.

Background: Transverse sternal nonunion is a rare but disabling complication of the chest trauma or less commonly a transverse sternotomy. Fixation methods, which are mainly used to manage the more common longitudinal sternal nonunion, often fail leaving surgical treatment of transverse nonunion as a challenge.Case presentation: We present a case of a highly disabling postoperative chest wall defect resulting from transverse sternal nonunion after a transverse thoracosternotomy (clamshell incision) and a concomitant rib resection. Following unsuccessful surgical attempts, sternal nonunion was fixed by a tibial locking plate and bone grafted, while the chest defect after the rib resection was reconstructed by a Gore-Tex dual mesh membrane. Adequate chest stability was achieved enabling complete healing of the sternal nonunion and a good outcome in our patient.Conclusion: We believe that in a rare combined postoperative transverse sternal nonunion and the chest wall defect after rib resection, it is important to address both. In our patient a good outcome was achieved after fixing nonunion by a properly sized and shaped locking plate with bone grafting and covering the chest defect by a dual mesh membrane.

Design, additive manufacture and clinical application of a patient-specific titanium implant to anatomically reconstruct a large chest wall defect

Purpose Chest wall reconstruction of large oncological defects following resection is challenging. Traditional management involves the use of different materials that surgeons creatively shape intraoperatively to restore the excised anatomy. This is time-consuming, difficult to mould into shape and causes some complications such as dislocation or paradoxical movement. This study aims to present the development and clinical implantation of a novel custom-made three-dimensional (3D) laser melting titanium alloy implant that reconstructs a large chest wall resection and maintains the integrity of the thoracic cage. Design/methodology/approach The whole development process of the novel implant is described: design specifications, computed tomography (CT) scan manipulation, 3D computer-assisted design (CAD), rapid prototyping, final manufacture and clinical implantation. A multidisciplinary collaboration in between engineers and surgeons guided the iterative design process. Findings The implant provided excellent aesthetical and functional results. The virtual planning and production of the implant prior to surgery reduced surgery time and uncertainty. It also improved safety and accuracy. The implant sited nicely on the patient anatomy after resection following the virtual plan. At six months following implantation, there were no implant-related complications of pain, infection, dislocation or paradoxical movement. This technique offered a fast lead-time for implant production, which is crucial for oncological treatment. Research limitations/implications More cases and a long-term follow-up are needed to confirm and quantify the benefits of this procedure; further research is also required to design a solution that better mimics the chest wall biomechanics while preventing implant complications. Originality/value The authors present a novel custom thoracic implant that provided a satisfactory reconstruction of a large chest wall defect, developed and implanted within three weeks to address a fast-growing chondrosarcoma. Furthermore, the authors describe its development process in detail as a design guideline, discussing potential improvements and critical design considerations so that this study can be replicated for future cases.