Eur J Pediatr Surg
DOI: 10.1055/a-2013-3074
Review Article

Reconstructive Strategies in Pediatric Patients after Oncological Chest Wall Resection: A Systematic Review

1   Department of Plastic, Reconstructive, and Hand Surgery, University Medical Center Utrecht, Wilhelmina Children's Hospital and Princess Máxima Center, Utrecht, the Netherlands
Zachri N. Ovadja
1   Department of Plastic, Reconstructive, and Hand Surgery, University Medical Center Utrecht, Wilhelmina Children's Hospital and Princess Máxima Center, Utrecht, the Netherlands
Caroline C.C. Hulsker
2   Department of Pediatric Surgery, Princess Máxima Center, Utrecht, the Netherlands
Michiel A.J. van de Sande
3   Department of Orthopedic Surgery, Princess Máxima Center, Utrecht, the Netherlands
Cornelis P. van de Ven
2   Department of Pediatric Surgery, Princess Máxima Center, Utrecht, the Netherlands
Emma C. Paes
1   Department of Plastic, Reconstructive, and Hand Surgery, University Medical Center Utrecht, Wilhelmina Children's Hospital and Princess Máxima Center, Utrecht, the Netherlands
› Author Affiliations


An appropriate reconstruction strategy after surgical resection of chest wall tumors in children is important to optimize outcomes, but there is no consensus on the ideal approach. The aim of this study was to provide an up-to-date systematic review of the literature for different reconstruction strategies for chest wall defects in patients less than 18 years old. A systematic literature search of the complete available literature was performed and results were analyzed. A total of 22 articles were included in the analysis, which described a total of 130 chest wall reconstructions. All were retrospective analyses, including eight case reports. Reconstructive options were divided into primary closure (n = 21 [16.2%]), use of nonautologous materials (n = 83 [63.8%]), autologous tissue repair (n = 2 [1.5%]), or a combination of the latter two (n = 24 [18.5%]). Quality of evidence was poor, and the results mostly heterogeneous. Reconstruction of chest wall defects can be divided into four major categories, with each category including its own advantages and disadvantages. There is a need for higher quality evidence and guidelines, to be able to report uniformly on treatment outcomes and assess the appropriate reconstruction strategy.

Publication History

Received: 07 December 2022

Accepted: 10 January 2023

Accepted Manuscript online:
14 January 2023

Article published online:
16 March 2023

© 2023. Thieme. All rights reserved.

Georg Thieme Verlag KG
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  • References

  • 1 Kumar AP, Green AL, Smith JW, Pratt CB. Combined therapy for malignant tumors of the chest wall in children. J Pediatr Surg 1977; 12 (06) 991-999
  • 2 Shamberger RC, Grier HE. Chest wall tumors in infants and children. Semin Pediatr Surg 1994; 3 (04) 267-276
  • 3 Dang NC, Siegel SE, Phillips JD. Malignant chest wall tumors in children and young adults. J Pediatr Surg 1999; 34 (12) 1773-1778
  • 4 La Quaglia MP. Chest wall tumors in childhood and adolescence. Semin Pediatr Surg 2008; 17 (03) 173-180
  • 5 Basharkhah A, Lackner H, Karastaneva A. et al. Interdisciplinary radical “En-Bloc” resection of Ewing sarcoma of the chest wall and simultaneous chest wall repair achieves excellent long-term survival in children and adolescents. Front Pediatr 2021; 9 (March): 661025 DOI: 10.3389/fped.2021.661025.
  • 6 Gapany C, Raffoul W, Zambelli P-Y, Joseph J-M. Latissimus dorsi muscle-flap over Gore-Tex patch for coverage of large thoracic defects in paediatric Ewing sarcoma. Pediatr Blood Cancer 2009; 52 (05) 679-681
  • 7 Lopez C, Correa A, Vaporciyan A, Austin M, Rice D, Hayes-Jordan A. Outcomes of chest wall resections in pediatric sarcoma patients. J Pediatr Surg 2017; 52 (01) 109-114
  • 8 Sandler G, Hayes-Jordan A. Chest wall reconstruction after tumor resection. Semin Pediatr Surg 2018; 27 (03) 200-206
  • 9 Aragón J, Pérez Méndez I. Dynamic 3D printed titanium copy prosthesis: a novel design for large chest wall resection and reconstruction. J Thorac Dis 2016; 8 (06) E385-E389
  • 10 Vannucci J, Scarnecchia E, Potenza R, Ceccarelli S, Monopoli D, Puma F. Dynamic titanium prosthesis based on 3D-printed replica for chest wall resection and reconstruction. Transl Lung Cancer Res 2020; 9 (05) 2027-2032
  • 11 Moher D, Liberati A, Tetzlaff J, Altman DG. PRISMA Group. Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement. BMJ 2009; 339: b2535-b2535
  • 12 Slim K, Nini E, Forestier D, Kwiatkowski F, Panis Y, Chipponi J. Methodological index for non-randomized studies (minors): development and validation of a new instrument. ANZ J Surg 2003; 73 (09) 712-716
  • 13 Gülhan SSE, Adams PY, Sarica EA, Turut H, Agackiran Y. Chest wall lipoblastoma in a seven-month-old girl: a case report. J Pediatr Surg 2004; 39 (09) 1414-1417
  • 14 Kane G, Orr D, Pears J, McGuinness J. A novel approach to extensive chest wall reconstruction in a child. Ann Thorac Surg 2021; 111 (06) e389-e391
  • 15 Kumar APS, Kajamohideen S, Venkitaraman B, Bose SJC, Shivkumaran SM, Premkumar P. Thoracoscopic (hybrid) complex chest wall resection in pediatric Ewing sarcoma. Asian Cardiovasc Thorac Ann 2021; 29 (02) 128-131
  • 16 Makarawo TP, Reynolds RA, Cullen ML. Polylactide bioabsorbable struts for chest wall reconstruction in a pediatric patient. Ann Thorac Surg 2015; 99 (02) 689-691
  • 17 Sunil I, Bond SJ, Nagaraj HS. Primitive neuroectodermal tumor of the sternum in a child: resection and reconstruction. J Pediatr Surg 2006; 41 (11) e5-e8
  • 18 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
  • 19 Aihole JS. A rare case of chest wall reconstruction in a child. Int J Surg Case Rep 2021; 84 (May): 106123 DOI: 10.1016/j.ijscr.2021.106123.
  • 20 Golant A, Lou JE, Erol B, Gaynor JW, Low DW, Dormans JP. 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
  • 21 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
  • 22 Colella S, Brandimarte A, Marra R. et al. Chest wall reconstruction in benign and malignant tumors with non-rigid materials: an overview. Front Surg 2022; 9: 976463 DOI: 10.3389/fsurg.2022.976463.
  • 23 Losken A, Thourani VH, Carlson GW. et al. A reconstructive algorithm for plastic surgery following extensive chest wall resection. Br J Plast Surg 2004; 57 (04) 295-302
  • 24 Sanna S, Brandolini J, Pardolesi A. et al. Materials and techniques in chest wall reconstruction: a review. J Vis Surg 2017; 3: 95-95
  • 25 Seder CW, Rocco G. Chest wall reconstruction after extended resection. J Thorac Dis 2016; 8 (Suppl 11): S863-S871
  • 26 Mahabir R, Butler C. Stabilization of the chest wall: autologous and alloplastic reconstructions. Semin Plast Surg 2011; 25 (01) 34-42
  • 27 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
  • 28 le Roux BT, Shama DM. Resection of tumors of the chest wall. Curr Probl Surg 1983; 20 (06) 345-386
  • 29 Baumann DP, Butler CE. Bioprosthetic mesh in abdominal wall reconstruction. Semin Plast Surg 2012; 26 (01) 18-24
  • 30 FitzGerald JF, Kumar AS. Biologic versus synthetic mesh reinforcement: what are the pros and cons?. Clin Colon Rectal Surg 2014; 27 (04) 140-148
  • 31 Eppley BL, Morales L, Wood R. et al. Resorbable PLLA-PGA plate and screw fixation in pediatric craniofacial surgery: clinical experience in 1883 patients. Plast Reconstr Surg 2004; 114 (04) 850-856 , discussion 857
  • 32 Novitsky YW, Rosen MJ. The biology of biologics: basic science and clinical concepts. Plast Reconstr Surg 2012; 130 (5, Suppl 2): 9S-17S
  • 33 Hunter III JD, Cannon JA. Biomaterials: so many choices, so little time. What are the differences?. Clin Colon Rectal Surg 2014; 27 (04) 134-139
  • 34 Oliveira C, Zamakhshary M, Alfadda T. et al. An innovative method of pediatric chest wall reconstruction using Surgisis and swinging rib technique. J Pediatr Surg 2012; 47 (05) 867-873
  • 35 de Castro Brás LE, Shurey S, Sibbons PD. Evaluation of crosslinked and non-crosslinked biologic prostheses for abdominal hernia repair. Hernia 2012; 16 (01) 77-89
  • 36 Lin SR, Kastenberg ZJ, Bruzoni M, Albanese CT, Dutta S. Chest wall reconstruction using implantable cross-linked porcine dermal collagen matrix (Permacol). J Pediatr Surg 2012; 47 (07) 1472-1475
  • 37 Iarussi T, Pardolesi A, Camplese P, Sacco R. Composite chest wall reconstruction using titanium plates and mesh preserves chest wall function. J Thorac Cardiovasc Surg 2010; 140 (02) 476-477
  • 38 Billè A, Okiror L, Karenovics W, Routledge T. Experience with titanium devices for rib fixation and coverage of chest wall defects. Interact Cardiovasc Thorac Surg 2012; 15 (04) 588-595
  • 39 De Palma A, Sollitto F, Loizzi D. et al. Chest wall stabilization and reconstruction: short and long-term results 5 years after the introduction of a new titanium plates system. J Thorac Dis 2016; 8 (03) 490-498
  • 40 Waldhausen JHT, Redding G, White K, Song K. Complications in using the vertical expandable prosthetic titanium rib (VEPTR) in children. J Pediatr Surg 2016; 51 (11) 1747-1750
  • 41 Stephenson JT, Song K, Avansino JR, Mesher A, Waldhausen JHT. Novel titanium constructs for chest wall reconstruction in children. J Pediatr Surg 2011; 46 (05) 1005-1010
  • 42 Saltsman JA, Danzer E, Hammond WJ. et al. Survival and scoliosis following resection of chest wall tumors in children and adolescents: a single-center retrospective analysis. Ann Surg 2021; 274 (02) e167-e173
  • 43 Grosfeld JL, Rescorla FJ, West KW. et al. Chest wall resection and reconstruction for malignant conditions in childhood. J Pediatr Surg 1988; 23 (07) 667-673
  • 44 Scalabre A, Parot R, Hameury F, Cunin V, Jouve J-L, Chotel F. Prognostic risk factors for the development of scoliosis after chest wall resection for malignant tumors in children. J Bone Joint Surg Am 2014; 96 (02) e10 DOI: 10.2106/JBJS.L.01535.
  • 45 Glotzbecker MP, Gold M, Puder M, Hresko MT. Scoliosis after chest wall resection. J Child Orthop 2013; 7 (04) 301-307
  • 46 Jackson L, Singh M, Parikh D. A technical innovation in paediatric chest wall reconstruction. Pediatr Surg Int 2011; 27 (06) 629-633
  • 47 Ng CSH. Recent and future developments in chest wall reconstruction. Semin Thorac Cardiovasc Surg 2015; 27 (02) 234-239
  • 48 Pontiki AA, Natarajan S, Parker FNH. et al. Chest wall reconstruction using 3-dimensional printing: functional and mechanical results. Ann Thorac Surg 2022; 114 (03) 979-988
  • 49 Zhang Y, Fang S, Dai J. et al. Experimental study of ASCs combined with POC-PLA patch for the reconstruction of full-thickness chest wall defects. PLoS One 2017; 12 (08) e0182971 DOI: 10.1371/journal.pone.0182971.
  • 50 Tang H, Wu B, Qin X, Zhang L, Kretlow J, Xu Z. Tissue engineering rib with the incorporation of biodegradable polymer cage and BMSCs/decalcified bone: an experimental study in a canine model. J Cardiothorac Surg 2013; 8 (01) 133 DOI: 10.1186/1749-8090-8-133.