En bloc resection of chest wall tumors with wide margins can generate wall defects which affect structural function and interfere in respiratory mechanics. Restoration of wall integrity is a surgical challenge, due to the complexity of reconstructing the structural rigidity of the thoracic cage, while preserving the elasticity required for the mechanics of breathing.1

We report the case of an 84-year-old woman who underwent resection of a giant chondrosarcoma. We were able to reconstruct the resulting large chest wall defect using a previously unpublished technique, which meets both rigidity and elasticity requirements.

The resection included the tumor, skin, soft tissue, ribs 2–5, and the lateral half of the sternum (Fig. 1). The resulting large chest wall defect was repaired using preformed surgical steel bars usually used for video-assisted surgical correction of congenital deformities of the chest wall (Walter Lorenz®). The bars were placed to mimic the form of the costal arches, and fixed using Dall-Miles® cerclage with steel cables and dedicated stabilizers screwed to the remaining sternum (Fig. 1). Polytetrafluoroethylene (PTFE) mesh (Gore-Tex®) was used to seal the pleural cavity (Fig. 1). No perioperative complications occurred, and 4 years after the intervention the patient remains symptomatic with no signs of tumor relapse.

Fig. 1.

Large chest wall defect after resection. Reconstruction with 2 pectus bars and PTFE mesh.

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Chest wall defect repair with biological substitutes or prosthetics is necessary when the defect is greater than 4 costal arches or 5cm, and is of particular significance when the resection involves the anterior chest wall, as in our case. Most of the rigid prostheses and metal meshes or cement2 currently available for reconstruction provide the necessary rigidity but lack the necessary elasticity, while commercially available rib substitutes provide better thoracic compliance, but are limited in terms of length and rigidity.

In our case, the pectus bars were long enough to repair the large chest wall defect, while the stabilizers we used provided secure and stable fixation of the bars to the remaining sternum. Moreover, subsequent fixing of the bars with steel cable gave added stability. From a mechanical point of view, shaping the bars in the form of arches transfers the compression forces to the bony supports at each end, so the proposed technique can support significant loads. The PTFE mesh tightly sutured to the edges of the defect adapts easily to the wound perimeter, completely sealing the pleural cavity. The arrangement of an elastic, sealed pleural cavity, supported by arches, allows for chest wall mobility and the reestablishment of the play of pleural pressures required for effective ventilation.3 To conclude, we present a more physiological reconstructive technique which may have a positive impact on functional recovery.