Reconstruction of massive chest wall defects: A 20-year experience

Joseph P. Corkum, Patrick B. Garvey, Donald P. Baumann, Jasson Abraham, Jun Liu, Wayne Hofstetter, Charles E. Butler, Mark W. Clemens

Research output: Contribution to journalArticlepeer-review

1 Scopus citations

Abstract

Background: Large chest wall resections can result in paradoxical chest wall movement leading to prolonged ventilator dependence and major respiratory impairment. The purpose of this study was to determine as to which factors are predictive or protective of complications in massive oncologic chest wall defect reconstructions. Methods: A retrospective review of a prospectively maintained database of consecutive patients who underwent immediate reconstruction of massive thoracic oncologic defects (≥5 ribs) was performed. Univariate and multivariate logistic regression analyses identified risk factors. Results: We identified 59 patients (median age, 53 years) with a mean follow-up of 36 months. Rib resections ranged from 5 to 10 ribs (defect area, 80–690 cm2). Sixty-two percent of the patients developed at least one postoperative complication. Superior/middle resections were associated with increased risk of general and pulmonary complications (71.4% vs. 35.3%; OR 4.54; p = 0.013). The 90-day mortality rate following massive chest wall resection and reconstruction was 8.5%. Two factors that were significantly associated with shorter overall survival time were preoperative XRT and preoperative chemotherapy (p = 0.021 and p < 0.001, respectively). Conclusions: Patients with massive oncological thoracic defects have a high rate of reconstructive complications, particularly pulmonary, leading to prolonged ventilator dependence. Superior resections were more likely to be associated with increased pulmonary and overall complications. The length of postoperative recovery was significantly associated with the size of the defect, and larger defects had prolonged hospital stays. Because of the large dimensions of chest wall defects, almost half of the cases required flap coverage to allow for appropriate defect closure. Understanding the unique demands of these rare but challenging cases is critically important in predicting patient outcomes.

Original languageEnglish (US)
Pages (from-to)1091-1098
Number of pages8
JournalJournal of Plastic, Reconstructive and Aesthetic Surgery
Volume73
Issue number6
DOIs
StatePublished - Jun 2020

Keywords

  • Massive chest wall defect
  • Reconstruction
  • Thoracic

ASJC Scopus subject areas

  • Surgery

Fingerprint Dive into the research topics of 'Reconstruction of massive chest wall defects: A 20-year experience'. Together they form a unique fingerprint.

Cite this