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Reconstruction of Complex Anterior Chest Wall Defects: The Lasagna Technique

BACKGROUND: Sternal tumors are rare, comprising only 0.94% of all bone tumors, with the majority being sarcomas. An extensive composite defect is often the result of surgical resection. Reconstruction of this anatomical area is a challenge for plastic surgeons. Reconstruction must fulfil two differe...

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Autores principales: Baccarani, Alessio, Filosso, Pierluigi, Marra, Caterina, De Maria, Federico, Blessent, Claudio Gio Francesco, Ruggiero, Ciro, Pappalardo, Marco, Pedone, Antonio, De Santis, Giorgio
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Lippincott Williams & Wilkins 2023
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10642906/
https://www.ncbi.nlm.nih.gov/pubmed/37964922
http://dx.doi.org/10.1097/GOX.0000000000005384
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author Baccarani, Alessio
Filosso, Pierluigi
Marra, Caterina
De Maria, Federico
Blessent, Claudio Gio Francesco
Ruggiero, Ciro
Pappalardo, Marco
Pedone, Antonio
De Santis, Giorgio
author_facet Baccarani, Alessio
Filosso, Pierluigi
Marra, Caterina
De Maria, Federico
Blessent, Claudio Gio Francesco
Ruggiero, Ciro
Pappalardo, Marco
Pedone, Antonio
De Santis, Giorgio
author_sort Baccarani, Alessio
collection PubMed
description BACKGROUND: Sternal tumors are rare, comprising only 0.94% of all bone tumors, with the majority being sarcomas. An extensive composite defect is often the result of surgical resection. Reconstruction of this anatomical area is a challenge for plastic surgeons. Reconstruction must fulfil two different tasks: restoration of soft tissues and stabilization of the chest wall. Both are well defined, and many techniques have been historically proposed. METHODS: We present the case of a 66-year-old man affected by sternal metastasis of lung non-small cell carcinoma with sarcomatoid features. After wide tumor resection, a large defect was created. RESULTS: The patient underwent a complex multilayer reconstruction that combined multiple techniques: Gore DualMesh to reconstruct the pericardial plane and protect the heart muscle, omental flap to facilitate integration of the mesh, titanium bars to recreate chest wall stability, and bilateral pectoralis muscle flaps to cover hardware. This multilayer reconstruction was named the “lasagna technique.” CONCLUSIONS: Due to the rarity of primary malignancies of the sternum, it is difficult to standardize a therapeutic approach. For this reason, it is necessary to customize the surgical treatment by combining several techniques and materials. Our lasagna technique may be considered a valuable option in treating these complex reconstructive cases.
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spelling pubmed-106429062023-11-14 Reconstruction of Complex Anterior Chest Wall Defects: The Lasagna Technique Baccarani, Alessio Filosso, Pierluigi Marra, Caterina De Maria, Federico Blessent, Claudio Gio Francesco Ruggiero, Ciro Pappalardo, Marco Pedone, Antonio De Santis, Giorgio Plast Reconstr Surg Glob Open Reconstructive BACKGROUND: Sternal tumors are rare, comprising only 0.94% of all bone tumors, with the majority being sarcomas. An extensive composite defect is often the result of surgical resection. Reconstruction of this anatomical area is a challenge for plastic surgeons. Reconstruction must fulfil two different tasks: restoration of soft tissues and stabilization of the chest wall. Both are well defined, and many techniques have been historically proposed. METHODS: We present the case of a 66-year-old man affected by sternal metastasis of lung non-small cell carcinoma with sarcomatoid features. After wide tumor resection, a large defect was created. RESULTS: The patient underwent a complex multilayer reconstruction that combined multiple techniques: Gore DualMesh to reconstruct the pericardial plane and protect the heart muscle, omental flap to facilitate integration of the mesh, titanium bars to recreate chest wall stability, and bilateral pectoralis muscle flaps to cover hardware. This multilayer reconstruction was named the “lasagna technique.” CONCLUSIONS: Due to the rarity of primary malignancies of the sternum, it is difficult to standardize a therapeutic approach. For this reason, it is necessary to customize the surgical treatment by combining several techniques and materials. Our lasagna technique may be considered a valuable option in treating these complex reconstructive cases. Lippincott Williams & Wilkins 2023-11-13 /pmc/articles/PMC10642906/ /pubmed/37964922 http://dx.doi.org/10.1097/GOX.0000000000005384 Text en Copyright © 2023 The Authors. Published by Wolters Kluwer Health, Inc. on behalf of The American Society of Plastic Surgeons. https://creativecommons.org/licenses/by-nc-nd/4.0/This is an open-access article distributed under the terms of the Creative Commons Attribution-Non Commercial-No Derivatives License 4.0 (CCBY-NC-ND) (https://creativecommons.org/licenses/by-nc-nd/4.0/) , where it is permissible to download and share the work provided it is properly cited. The work cannot be changed in any way or used commercially without permission from the journal.
spellingShingle Reconstructive
Baccarani, Alessio
Filosso, Pierluigi
Marra, Caterina
De Maria, Federico
Blessent, Claudio Gio Francesco
Ruggiero, Ciro
Pappalardo, Marco
Pedone, Antonio
De Santis, Giorgio
Reconstruction of Complex Anterior Chest Wall Defects: The Lasagna Technique
title Reconstruction of Complex Anterior Chest Wall Defects: The Lasagna Technique
title_full Reconstruction of Complex Anterior Chest Wall Defects: The Lasagna Technique
title_fullStr Reconstruction of Complex Anterior Chest Wall Defects: The Lasagna Technique
title_full_unstemmed Reconstruction of Complex Anterior Chest Wall Defects: The Lasagna Technique
title_short Reconstruction of Complex Anterior Chest Wall Defects: The Lasagna Technique
title_sort reconstruction of complex anterior chest wall defects: the lasagna technique
topic Reconstructive
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10642906/
https://www.ncbi.nlm.nih.gov/pubmed/37964922
http://dx.doi.org/10.1097/GOX.0000000000005384
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