Abstract
Aim Primary thoracic wall malignancy is a rare and diverse entity in children. Surgical
treatment commonly involves major chest wall resection causing large defects requiring
complex reconstruction. In adults, the use of alloplastic and/or xenogenic materials
and muscle flap repair is well established. However, literature provides only little
information on procedures in children. We report our experience in 8 consecutive children
who underwent chest wall resection and reconstruction with regard to surgical treatment
and outcome.
Patients and Methods Retrospective study of all children with primary malignant chest wall tumors requiring
rib resection and reconstruction with prosthetic material performed in our institution
between November 2002 and April 2010. Endpoints were postoperative complications and
long-term results, focusing on scoliosis defined radiologically by the Cobb angle.
Results 8 children (7 male, 1 female) with a median age of 10.6 (4.1–18.9) years underwent
resection of thoracic wall tumors. A mean number of 3 (1–5) ribs were resected. Stability
was obtained using rigid prosthetic material (STRATOS™ titanium bar) in 2 patients
and/or non-rigid prosthetic material (Goretex® patch in 6 patients, Vicryl® patch in 3 patients, Tutopatch® in 1 patient). A muscular flap was added in 5 patients. Postoperative complications
included superficial wound infection (n = 2) and dislocation of a titanium bar necessitating removal in 1 patient. No infections
of the prosthetic material were observed. No perioperative mortality occurred. At
a mean follow-up of 37.5 (4–97) months, 6 patients were alive. 2 patients died due
to early tumor recurrence. Mild scoliosis (Cobb angle 10–20°) was detected in 2 of
the surviving patients (33%).
Conclusion Surgical reconstruction after resection of malignant thoracic wall tumors using non-rigid
prosthetic material is safe and effective in pediatric patients, whereas rigid prosthetic
material might dislocate. Scoliosis represents a long-term complication after chest
wall reconstruction and should be monitored during routine follow-up.
Keywords
primary malignant thoracic wall tumor - reconstruction - prosthetic material - children
- outcome
