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Complex anterior chest wall reconstruction after extensive oncologic resections: a narrative review

OBJECTIVE: This report serves to showcase four cases of rare, malignant primary neoplasms of the anterior chest wall [chondrosarcoma and basal cell carcinoma (BCC)] that thoracic surgeons may encounter, and different approaches to complex reconstruction that may be necessary following resection. BAC...

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Autores principales: Gritsiuta, Andrei I., Bracken, Alexander, Abbas, Abbas E., Petrov, Roman V.
Formato: Online Artículo Texto
Lenguaje:English
Publicado: 2021
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9049198/
https://www.ncbi.nlm.nih.gov/pubmed/35495182
http://dx.doi.org/10.21037/shc-21-8
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author Gritsiuta, Andrei I.
Bracken, Alexander
Abbas, Abbas E.
Petrov, Roman V.
author_facet Gritsiuta, Andrei I.
Bracken, Alexander
Abbas, Abbas E.
Petrov, Roman V.
author_sort Gritsiuta, Andrei I.
collection PubMed
description OBJECTIVE: This report serves to showcase four cases of rare, malignant primary neoplasms of the anterior chest wall [chondrosarcoma and basal cell carcinoma (BCC)] that thoracic surgeons may encounter, and different approaches to complex reconstruction that may be necessary following resection. BACKGROUND: Approximately 60% of the anterior chest wall neoplasms are malignant. The most common types of primary sternal tumors are chondrosarcoma and osteosarcoma. While guidelines for resection of these tumors have been previously described in the literature, guidelines regarding reconstructive techniques of the subsequent large defects are infrequently demonstrated. METHODS: The medical records of four adult patients with primary chest wall tumors who underwent resection of the sternum from October 2016 to March 2021 were retrospectively reviewed. Radical resection with tumor-free surgical margins offers the best chance for survival, but results in a wide full-thickness defect. Hence, closure of the anterior chest wall defect with skeletal reconstruction is an essential step of the procedure and allows us to highlight surgical techniques and materials that have been used over recent years. Methods described herein include skeletal reconstruction with various hardware or allograft, as well as defect coverage using regional flaps, free tissue transfer, and mesh. CONCLUSIONS: Primary chest wall tumors of the sternum are an extremely rare diagnosis with a high malignancy rate. Full-thickness radical en-bloc resection is the most effective treatment option. Subsequent reconstruction of a wide chest wall defect is the most challenging aspect, though crucial in the preservation of the rigidity of the chest wall and protection of underlying structures. Different techniques and materials have been described without clear guidelines in treatment approaches; this paper serves to delineate and describe techniques that achieved successful outcomes.
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spelling pubmed-90491982022-04-28 Complex anterior chest wall reconstruction after extensive oncologic resections: a narrative review Gritsiuta, Andrei I. Bracken, Alexander Abbas, Abbas E. Petrov, Roman V. Shanghai Chest Article OBJECTIVE: This report serves to showcase four cases of rare, malignant primary neoplasms of the anterior chest wall [chondrosarcoma and basal cell carcinoma (BCC)] that thoracic surgeons may encounter, and different approaches to complex reconstruction that may be necessary following resection. BACKGROUND: Approximately 60% of the anterior chest wall neoplasms are malignant. The most common types of primary sternal tumors are chondrosarcoma and osteosarcoma. While guidelines for resection of these tumors have been previously described in the literature, guidelines regarding reconstructive techniques of the subsequent large defects are infrequently demonstrated. METHODS: The medical records of four adult patients with primary chest wall tumors who underwent resection of the sternum from October 2016 to March 2021 were retrospectively reviewed. Radical resection with tumor-free surgical margins offers the best chance for survival, but results in a wide full-thickness defect. Hence, closure of the anterior chest wall defect with skeletal reconstruction is an essential step of the procedure and allows us to highlight surgical techniques and materials that have been used over recent years. Methods described herein include skeletal reconstruction with various hardware or allograft, as well as defect coverage using regional flaps, free tissue transfer, and mesh. CONCLUSIONS: Primary chest wall tumors of the sternum are an extremely rare diagnosis with a high malignancy rate. Full-thickness radical en-bloc resection is the most effective treatment option. Subsequent reconstruction of a wide chest wall defect is the most challenging aspect, though crucial in the preservation of the rigidity of the chest wall and protection of underlying structures. Different techniques and materials have been described without clear guidelines in treatment approaches; this paper serves to delineate and describe techniques that achieved successful outcomes. 2021-10 2021-10-30 /pmc/articles/PMC9049198/ /pubmed/35495182 http://dx.doi.org/10.21037/shc-21-8 Text en https://creativecommons.org/licenses/by-nc-nd/4.0/Open Access Statement: This is an Open Access article distributed in accordance with the Creative Commons Attribution-NonCommercial-NoDerivs 4.0 International License (CC BY-NC-ND 4.0), which permits the noncommercial replication and distribution of the article with the strict proviso that no changes or edits are made and the original work is properly cited (including links to both the formal publication through the relevant DOI and the license). See: https://creativecommons.org/licenses/by-nc-nd/4.0/.
spellingShingle Article
Gritsiuta, Andrei I.
Bracken, Alexander
Abbas, Abbas E.
Petrov, Roman V.
Complex anterior chest wall reconstruction after extensive oncologic resections: a narrative review
title Complex anterior chest wall reconstruction after extensive oncologic resections: a narrative review
title_full Complex anterior chest wall reconstruction after extensive oncologic resections: a narrative review
title_fullStr Complex anterior chest wall reconstruction after extensive oncologic resections: a narrative review
title_full_unstemmed Complex anterior chest wall reconstruction after extensive oncologic resections: a narrative review
title_short Complex anterior chest wall reconstruction after extensive oncologic resections: a narrative review
title_sort complex anterior chest wall reconstruction after extensive oncologic resections: a narrative review
topic Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9049198/
https://www.ncbi.nlm.nih.gov/pubmed/35495182
http://dx.doi.org/10.21037/shc-21-8
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