Composite reconstruction with cryopreserved fascia lata, single mandibular titanium plate, and polyglactin mesh after redo surgery and radiation therapy for recurrent chest wall liposarcoma.

摘要

Repeated chest wall resections after irradiation often mandate individualized reconstructive strategies. We report a case of a simplified reconstruction with a combination of materials recently used by thoracic surgeons because of their favorable biologic characteristics and user friendliness during implantation. CLINICAL SUMMARY A 68-year-old woman was referred from another institution for a biopsy-proved recurrent G2 liposarcoma of the lower right hemithorax at the level of the eighth to ninth ribs after prior incomplete surgical removal of the myocuta-neous layers and subsequent irradiation (70 Gy). Redo surgical intervention was performed by removing en bloc the involved chest wall, making sure to maintain the myocutane-ous resection line at 5 cm from the palpable tumor mass. Reconstruction was done by using a cryopreserved fascia lata homograft anchored to the remaining rib segments. In addition, a single mandibular titanium plate (Synthes, Solothurn, Switzerland) was used to bridge the bony defect (Figure 1, A and B). The shorter arm of this single plate was fixed with locking screws to the posterior segments of the uninvolved 2 lowermost ribs while the longer arm was anchored to the remaining anterolateral segment of the eighth rib. Given the absence of the overlying muscle and to avoid direct friction of the plate on the approximated skin edges, a polyglactin mesh was sutured to the muscle edges to cover the plate (Figure 1, C The postoperative course was uneventful, and the patient was discharged home 7 days after the operation. At the 3-month follow-up, the chest radiograph showed a satisfactory outcome (Figure 1, D).