J Reconstr Microsurg 2019; 35(08): 575-586
DOI: 10.1055/s-0039-1688717
Original Article
Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

Outcomes in Chest Wall Reconstruction Using Methyl Methacrylate Prostheses: A Review of the Literature and Case Series Utilizing a Novel Approach with Biologic Mesh

Nikhil R. Shah
1   Department of Surgery, Division of Plastic and Reconstructive Surgery, Rutgers New Jersey Medical School, Newark, New Jersey, United States
,
Haripriya S. Ayyala
1   Department of Surgery, Division of Plastic and Reconstructive Surgery, Rutgers New Jersey Medical School, Newark, New Jersey, United States
,
Bao Ngoc N. Tran
1   Department of Surgery, Division of Plastic and Reconstructive Surgery, Rutgers New Jersey Medical School, Newark, New Jersey, United States
,
Paul J. Therattil
1   Department of Surgery, Division of Plastic and Reconstructive Surgery, Rutgers New Jersey Medical School, Newark, New Jersey, United States
,
Jonathan D. Keith
1   Department of Surgery, Division of Plastic and Reconstructive Surgery, Rutgers New Jersey Medical School, Newark, New Jersey, United States
› Author Affiliations
Funding None.
Further Information

Publication History

23 December 2018

17 March 2019

Publication Date:
09 May 2019 (online)

Abstract

Background Composite defects after chest wall resection may leave patients at risk with lack of protection of vital structures and potentially respiratory compromise secondary to flail segments. Reconstruction of the chest wall with various alloplastic materials is possible and well described. Here, the authors present a novel technique in chest wall reconstruction utilizing a methyl methacrylate (MMA) “sandwich” with biologic mesh. The authors also sought to determine outcomes in chest wall reconstruction with MMA to optimize surgical decision making and minimize patient morbidity.

Methods A literature review was conducted using MEDLINE and the Cochrane Collaboration Library for primary research articles on chest wall reconstruction using MMA. Data related to surgical techniques and patient outcomes were extracted and analyzed. The authors also present their case series and outcomes utilizing a novel technique with biologic mesh.

Results Seventy-four articles met inclusion criteria, which included a total of 562 patients. Reconstruction methods included three main variations of the MMA prosthesis and six institution-specific variations. Complications were reported in 13.7% of patients; the most common complications included infection (5.6%), respiratory failure (3.3%), and atelectasis (1.7%). Less commonly reported complications included prosthesis dislocation (1.2%), pneumonia (1.0%), and lung collapse (0.4%). Overall mortality due to respiratory causes was observed in nine patients (1.6%). In our case series, complications included respiratory failure and seroma was reported in one patient, with no complications at long-term follow-up.

Conclusion There are a variety of options available for rigid and nonrigid prosthetic repair of the chest wall. We present the first successful reported case series of reconstruction using biologic mesh as a component of the MMA sandwich prosthesis. MMA appears to be a safe and effective choice for rigid reconstruction when used alone or in conjunction with synthetic or biologic mesh.

Authors' Contributions

Nikhil R. Shah: (1) conceived and designed the study, collected the data, analyzed and interpreted the data; (2) wrote the manuscript; and (3) approved the final version of the manuscript.


Haripriya S. Ayyala: (1) conceived and designed the study; (2) provided critical revisions that are important for the intellectual content; and (3) approved the final version of the manuscript.


Bao Ngoc N. Tran: (1) conceived and designed the study; (2) provided critical revisions that are important for the intellectual content; and (3) approved the final version of the manuscript.


Paul J. Therattil: (1) conceived and designed the study, collected the data; (2) provided critical revisions that are important for the intellectual content; and (3) approved the final version of the manuscript.


Jonathan D. Keith: (1) conceived and designed the study and analyzed and interpreted the data; (2) provided critical revisions that are important for the intellectual content; and (3) approved the final version of the manuscript.


 
  • References

  • 1 Weyant MJ, Bains MS, Venkatraman E. , et al. Results of chest wall resection and reconstruction with and without rigid prosthesis. Ann Thorac Surg 2006; 81 (01) 279-285
  • 2 McCormack P, Bains MS, Beattie Jr EJ, Martini N. New trends in skeletal reconstruction after resection of chest wall tumors. Ann Thorac Surg 1981; 31 (01) 45-52
  • 3 Mansour KA, Thourani VH, Losken A. , et al. Chest wall resections and reconstruction: a 25-year experience. Ann Thorac Surg 2002; 73 (06) 1720-1725 , discussion 1725–1726
  • 4 McKenna Jr. RJ, Mountain CF, McMurtrey MJ, Larson D, Stiles QR. Current techniques for chest wall reconstruction: expanded possibilities for treatment. Ann Thorac Surg 1988; 46 (05) 508-512
  • 5 Lardinois D, Müller M, Furrer M. , et al. Functional assessment of chest wall integrity after methylmethacrylate reconstruction. Ann Thorac Surg 2000; 69 (03) 919-923
  • 6 Aghajanzadeh M, Alavy A, Taskindost M, Pourrasouly Z, Aghajanzadeh G, Massahnia S. Results of chest wall resection and reconstruction in 162 patients with benign and malignant chest wall disease. J Thorac Dis 2010; 2 (02) 81-85
  • 7 le Roux BT, Shama DM. Resection of tumors of the chest wall. Curr Probl Surg 1983; 20 (06) 345-386
  • 8 McCormack PM. Use of prosthetic materials in chest-wall reconstruction. Assets and liabilities. Surg Clin North Am 1989; 69 (05) 965-976
  • 9 Mahabir RC, Butler CE. Stabilization of the chest wall: autologous and alloplastic reconstructions. Semin Plast Surg 2011; 25 (01) 34-42
  • 10 Kilic D, Gungor A, Kavukcu S. , et al. Comparison of mersilene mesh-methyl metacrylate sandwich and polytetrafluoroethylene grafts for chest wall reconstruction. J Invest Surg 2006; 19 (06) 353-360
  • 11 Hurwitz DJ, Ravitch MM, Wolmark N. Laminated Marlex-methyl methacrylate prosthesis for massive chest wall resection. Ann Plast Surg 1980; 5 (06) 486-490
  • 12 Campbell KT, Burns NK, Rios CN, Mathur AB, Butler CE. Human versus non-cross-linked porcine acellular dermal matrix used for ventral hernia repair: comparison of in vivo fibrovascular remodeling and mechanical repair strength. Plast Reconstr Surg 2011; 127 (06) 2321-2332
  • 13 Butler CE, Langstein HN, Kronowitz SJ. Pelvic, abdominal, and chest wall reconstruction with AlloDerm in patients at increased risk for mesh-related complications. Plast Reconstr Surg 2005; 116 (05) 1263-1275 , discussion 1276–1277
  • 14 Khalil HH, Kalkat M, Malahias MN. , et al. Chest wall reconstruction with Porcine Acellular Dermal Matrix (Strattice) and autologous tissue transfer for high risk patients with chest wall tumors. Plast Reconstr Surg Glob Open 2018; 6 (05) e1703
  • 15 Sanna S, Brandolini J, Pardolesi A. , et al. Materials and techniques in chest wall reconstruction: a review. J Vis Surg 2017; 3: 95-110
  • 16 Ferraro P, Cugno S, Liberman M, Danino MA, Harris PG. Principles of chest wall resection and reconstruction. Thorac Surg Clin 2010; 20 (04) 465-473
  • 17 Thomas PA, Brouchet L. Prosthetic reconstruction of the chest wall. Thorac Surg Clin 2010; 20 (04) 551-558
  • 18 Chapelier AR, Missana MC, Couturaud B. , et al. Sternal resection and reconstruction for primary malignant tumors. Ann Thorac Surg 2004; 77 (03) 1001-1006 , discussion 1006–1007
  • 19 Al-Refaie RE, Amer S, Ismail MF, Al-Shabrawy M, Al-Gamal G, Mokbel E. Chondrosarcoma of the chest wall: single-center experience. Asian Cardiovasc Thorac Ann 2014; 22 (07) 829-834
  • 20 Deschamps C, Tirnaksiz BM, Darbandi R. , et al. Early and long-term results of prosthetic chest wall reconstruction. J Thorac Cardiovasc Surg 1999; 117 (03) 588-591 , discussion 591–592
  • 21 Abate E, Banki F, Hagen JA, Klipfel N. Giant cell tumor of the sternum. Ann Thorac Surg 2009; 88 (02) 645-647
  • 22 Abubakar U, Legbo JN, Opara AC. , et al. Excision of a giant anterior chest wall neurofibroma and chest wall reconstruction with methlymethacrylate and vertical rectus abdominis musculocutaneous flap: case report. Niger J Med 2014; 23 (04) 344-350
  • 23 Akan M, Eker Uluçay G, Kargi B, Yildirim S, Aköz T. Combined reconstruction of complex defects of the chest wall. Scand J Plast Reconstr Surg Hand Surg 2006; 40 (02) 93-100
  • 24 Alifano M, Porrello C, Forti Parri SN, Casablanca G, Boaron M. Primary angiosarcoma of the chest wall. J Cardiovasc Surg (Torino) 2002; 43 (01) 127-128
  • 25 Altunkaya A, Aktunc E, Buyukates M, Kandemir O, Turan SA, Kutluk AC. Giant chest wall tumour invading the abdominal cavity: simultaneous reconstruction of the chest wall and hemidiaphragm. Can J Surg 2008; 51 (02) E30-E31
  • 26 Chaudhry Iu, Alhajji Z, Aldulaijan F, Mutairi H, Amr SS. Manubrioclavicular and Manubriosternal Reconstruction after radical resection for chondrosarcoma of manubriosternum: a modified surgical technique. Ann Thorac Surg 2015; 99 (06) e137-e139
  • 27 Cordeiro PG, Santamaria E, Hidalgo D. The role of microsurgery in reconstruction of oncologic chest wall defects. Plast Reconstr Surg 2001; 108 (07) 1924-1930
  • 28 Di Candia M, Wells FC, Malata CM. Anterolateral thigh free flap for complex composite central chest wall defect reconstruction with extrathoracic microvascular anastomoses. Plast Reconstr Surg 2010; 126 (05) 1581-1588
  • 29 Eng J, Sabanathan S, Mearns AJ. Chest wall reconstruction after resection of primary malignant chest wall tumours. Eur J Cardiothorac Surg 1990; 4 (02) 101-104
  • 30 Foroulis CN, Kleontas AD, Tagarakis G. , et al. Massive chest wall resection and reconstruction for malignant disease. Onco Targets Ther 2016; 9: 2349-2358
  • 31 Fouad FA. Chest wall resection and reconstruction: analysis of 11 cases after methylmethacrylate reconstruction. J Egypt Natl Canc Inst 2006; 18 (03) 175-182
  • 32 Galbis Caravajal JM, Yeste Sánchez L, Fuster Diana CA, et al. Sternal resection and reconstruction after malignant tumours. Clin Transl Oncol 2009; 11 (02) 91-95
  • 33 Golant A, Lou JE, Erol B, et al. Pediatric osteoblastoma of the sternum: a new surgical technique for reconstruction after removal: case report and review of the literature. J Pediatr Orthop 2004; 24 (03) 319-322
  • 34 Hanagiri T, Nozoe T, Yoshimatsu T, et al. Surgical treatment for chest wall invasion due to the local recurrence of breast cancer. Breast Cancer 2008; 15 (04) 298-302
  • 35 Hummelink K, IJsseldijk MA, Bosch AM, Ten Broek RP, van Engelenburg KC. Resention of a bony tumour of the chest wall with direct reconstruction using a sandwich techniqe: a standard technique for closure of large chest wall defects. J Surg Case Rep 2015 2015. (04). doi: 10.1093/jscr/rjv040
  • 36 Khalil HH, Malahias MN, Balasubramanian B. Multidisciplinary Oncoplastic Approach Reduces Infection in Chest Wall Resection and Reconstruction for Malignant Chest Wall Tumors. Plast Reconstr Surg Glob Open 2016; 4 (07) e809
  • 37 Kao CC, Rand RP, Stridde BC, Marchioro TL. Techniques in the composite reconstruction of extensive thoracoabdominal tumor resections. J Am Coll Surg 1995; 180 (02) 146-169
  • 38 Kiliç D, Erdogan B, Habesoglu MA, Hatipoglu A. Multiple primary chest wall hydatid cysts associated with spinal canal involvement. Interact Cardiovasc Thorac Surg 2003; 2 (03) 395-397
  • 39 Kilic D, Uysal C, Akdur A, et al. Chest wall implantation metastasis caused by percutaneous radiofrequency ablation for hepatic tumor. Ann Thorac Surg 2015; 99 (03) 1078-1080
  • 40 Lee SY, Lee SJ, Lee CS. Sternum resection and reconstruction for metastatic renal cell cancer. Int J Surg Case Rep 2011; 2 (04) 45-46
  • 41 Lopez C, Correa A, Vaporciyan A. Outcomes of chest wall resections in pediatric sarcoma patients. J Pediatr Surg 2017; 52 (01) 109-114
  • 42 Mahesh B, Clelland C, Ratnatunga C. Recurrent localized fibrous tumor of the pleura. Ann Thorac Surg 2006; 82 (01) 342-345
  • 43 Marcove RC, Egwele R, Searfoss R, Beattie Jr EJ, Brains MS. Chest wall reconstruction with methyl methacrylate implantation. Compr Ther 1977; 3 (12) 5-6
  • 44 Nakamura H, Kawasaki N, Taguchi M, Kitaya T. Reconstruction of the anterior chest wall after subtotal sternectomy for metastatic breast cancer: report of a case. Surg Today 2007; 37 (12) 1083-1086
  • 45 Nash AG, Tuson JR, Andrews SM, Stacey-Clear A. Chest wall reconstruction after resection of recurrent breast tumours. Ann R Coll Surg Engl 1991; 73 (02) 105-109
  • 46 Novoa N, Benito P, Jiménez MF. , et al. Reconstruction of chest wall defects after resection of large neoplasms: ten-year experience. Interact Cardiovasc Thorac Surg 2005; 4 (03) 250-255
  • 47 Okiror L, Khalil H, Vaiyapuri S, Kalkat M. Complete resection of a large phosphaturic mesenchymal tumour by chest wall resection and reconstruction. Gen Thorac Cardiovasc Surg 2016; 64 (06) 355-358
  • 48 Parker KL, Thistlethwaite P, Suliman AS. , et al. Staged repair of an aortic pseudoaneurysm secondary to delayed methylmeth
  • 49 Rathinam S, Venkateswaran R, Rajesh PB, Collins FJ. Reconstruction of the chest wall and the diaphragm using the inverted Y Marlex methylmethacrylate sandwich flap. Eur J Cardiothorac Surg 2004; 26 (01) 197-201
  • 50 Rocco G, Fazioli F, Scognamiglio F. , et al. The combination of multiple materials in the creation of an artificial anterior chest cage after extensive demolition for recurrent chondrosarcoma. J Thorac Cardiovasc Surg 2007; 133 (04) 1112-1114
  • 51 Rocco G, Martucci N, La Rocca A. Postoperative local morbidity and the use of vacuum-assisted closure after complex chest wall reconstructions with new and conventional materials. Ann Thorac Surg 2014; 98 (01) 291-296
  • 52 Sabanathan S, Shah R, Mearns AJ. Surgical treatment of primary malignant chest wall tumours. Eur J Cardiothorac Surg 1997; 11 (06) 1011-1016
  • 53 Sahin A, Meteroglu F, Eren S, Keles AN. A case of lymphoma simulating primary sternal tumour. APSP J Case Rep 2014; 5 (01) 2
  • 54 Shahzad F, Wong KY, Maraka J. Reconstruction of chest wall chondrosarcoma with an anterolateral thigh free flap: an illustration of decision-making in chest wall reconstruction. Int J Surg Case Rep 2013; 4 (08) 669-674
  • 55 Stanić V, Vulović T, Stamenović D, Dordević G. Use of marlex mesh with methylmethacrylate to repair large full-thickness defects after subtotal sternectomy caused by chondroma. Vojnosanit Pregl 2008; 65 (02) 175-177
  • 56 Tan PW, Wong CH, Koong HN, Tan BK. Chest wall reconstruction using a combined musculocutaneous anterolateral-anteromedial thigh flap. Indian J Plast Surg 2010; 43 (01) 88-91
  • 57 Tukiainen E. Chest wall reconstruction after oncological resections. Scand J Surg 2013; 102 (01) 9-13
  • 58 Ulku R, Onat S, Avci A, Ozmen CA. Resection of intercostal hemangioma with involved chest wall and ribs: in an 11-year-old girl. Tex Heart Inst J 2010; 37 (04) 486-489
  • 59 Vartanian SM, Colaco S, Orloff LE, Theodore PR. Oklahoma prosthesis: resection of tumor of clavicle and chest wall reconstructed with a custom composite graft. Ann Thorac Surg 2006; 82 (01) 332-334
  • 60 Wee HE, Akbar FA, Rajapaksha K, Aneez DB. Anterior chest wall resection and reconstruction for locally advanced breast cancer. Multimed Man Cardiothorac Surg 2015 2015. Doi: 10.1093/mmcts/mmv025
  • 61 Wong PS, Tan GP. Resection of large primary chest wall chondrosarcoma with reconstruction: 2 case reports. Med J Malaysia 2000; 55 (04) 516-519
  • 62 Jönsson P, Gyllstedt E, Hambraeus G, Lillogil R, Rydholm A. Chest wall sarcoma: outcome in 22 patients after resection requiring thoracic cage reconstruction. Sarcoma 1998; 2 (3-4): 143-147
  • 63 Eschapasse H, Gaillard J, Henry F. , et al. Repair of large chest wall defects: experience with 23 patients. Ann Thorac Surg 1981; 32 (04) 329-336
  • 64 Hasse J. Reconstruction of chest wall defects. Thorac Cardiovasc Surg 1991; Dec; 39 (Suppl. 03) 241-247
  • 65 Martini N, Huvos AG, Burt ME. Predictors of survival in malignant tumors of the sternum. J Thorac Cardiovasc Surg 1996; 111 (01) 96-105
  • 66 Noble J, Sirohi B, Ashley S, Ladas G, Smith I. Sternal/para-sternal resection for parasternal local recurrence in breast cancer. Breast 2010; 19 (05) 350-354
  • 67 Sung DF. Fibromatosis of the chest wall in children: a case report. Zhonghua Yi Xue Za Zhi (Taipei) 1992; 50 (03) 261-265
  • 68 Tocchi A, Puma F, Cerroni M, Fornasari V, Daddi Jr G. Synthetic prostheses in repair of chest wall defects after exeresis of malignancies. Int Surg 1987; 72 (01) 34-37
  • 69 Traibi A, Boulahya A, Ihrai H, Oukabli M, Kabiri el H. Giant cell tumors that originated in the sternum. Gen Thorac Cardiovasc Surg 2011; 59 (02) 148-151
  • 70 Walsh GL, Davis BM, Swisher SG. , et al. A single-institutional, multidisciplinary approach to primary sarcomas involving the chest wall requiring full-thickness resections. J Thorac Cardiovasc Surg 2001; 121 (01) 48-60
  • 71 Aoki T, Ozeki Y, Watanabe M. Development of primary leiomyosarcoma of the sternum postirradiation: report of a case. Surg Today 1998; 28 (12) 1326-1328
  • 72 Arango Tomás E, Baamonde Laborda C, Algar Algar J, Salvatierra Velázquez A. Chest wall reconstruction with methacrylate prosthesis in Poland syndrome. Arch Bronconeumol 2013; 49 (10) 450-452
  • 73 Chapelier A, Macchiarini P, Rietjens M. Chest wall reconstruction following resection of large primary malignant tumors. Eur J Cardiothorac Surg 1994; 8 (07) 351-356
  • 74 Hasse J. Surgery for primary, invasive and metastatic malignancy of the chest wall. Eur J Cardiothorac Surg 1991; 5 (07) 346-351
  • 75 Imai K, Minamiya Y, Saito H. , et al. Giant cell tumor of the sternum. Jpn J Thorac Cardiovasc Surg 2006; 54 (09) 405-408
  • 76 Jazzar AS, Dalton WE, Bradley NE, Cooper DK, Zuhdi N. Methyl methacrylate plate to prevent compression after heart transplantation. Ann Thorac Surg 1993; 55 (05) 1242-1243
  • 77 París F, Blasco E, Tarazona V. , et al. Total sternectomy for malignant disease. J Thorac Cardiovasc Surg 1980; 80 (03) 459-462
  • 78 Yokoyama H, Togo T, Murata S. , et al. Cardiac dilatation after cardiopulmonary bypass: ceramic plate technique for sternal splinting. Ann Thorac Surg 1993; 56 (04) 971-972
  • 79 Suzuki K, Park BJ, Adusumilli PS. , et al. Chest Wall Reconstruction Using a Methyl Methacrylate Neo-rib and Mesh. Ann Thorac Surg 2015; 100 (02) 744-747
  • 80 Suzuki T, Suzuki S, Kitami A, Hori G, Sumiya N. Reconstruction of chest wall after full-thickness resection. Two case reports. Scand J Thorac Cardiovasc Surg 1995; 29 (03) 145-147
  • 81 Suzuki T, Hori G, Kitami A, Suzuki K, Suzuki S. Reconstruction of anterior chest wall defect with ceramic bone grafts--a case of localized malignant mesothelioma. Nihon Kyobu Geka Gakkai Zasshi 1991; 39 (03) 322-325
  • 82 Robinson LA, Grubbs DM. Using “Rebar” to Stabilize Rigid Chest Wall Reconstruction. Thorac Cardiovasc Surg 2016; 64 (03) 266-269
  • 83 Kim KA, Vincent WR, Muenchow SK, Wells WJ, Downey SE. Successful repair of ectopia cordis using alloplastic materials. Ann Plast Surg 1997; 38 (05) 518-522