Chest wall reconstruction with titanium plates after desmoid tumor resection

Chest wall reconstruction becomes necessary when there are wall defects larger than 5 cm in diameter that compromise respiratory dynamics. Its purpose is to restore wall integrity, as well as to maintain waterproofing of the pleura, an aesthetic chest contour, and respiratory dynamics. In addition, the purpose is to protect vital intrathoracic organs, thus preventing lung herniation and paradoxical breathing and preserving lung compliance. The indication for bony reconstruction of the chest wall is related to the size and location of the defect. Defects in the anterior, lateral, and sternal wall require reconstruction, whereas defects in the posterior wall can be covered by the posterior muscles or by the scapula and do not require the use of prostheses. There is as yet no consensus on the ideal material for use in rib reconstruction. The literature suggests the use of prostheses consisting of titanium plates (STRATOS™, Strasbourg Thoracic Osteosynthesis System; Diagnostic Medical Systems, Pérols, France) for that purpose, and, therefore, we report the case of a 25-year-old female patient who presented with a nearly one-year history of chest pain and dyspnea, as well as with a volume increase in the left costal margin. Physical examination revealed a tumor in the lower third of the anterior chest wall, affecting the left thoracoabdominal junction. An axial CT scan of the chest showed a soft-tissue tumor that affected the region of the left anterior costal margin, extended to the abdominal region, and compressed the left hepatic lobe, the anterior pericardium, and the lung parenchyma in the left lower lobe. However, there were no signs of structural invasion. The tumor measured 12.0 × 11.0 × 7.5 cm. The patient underwent chest wall resection, which included soft tissues and the anterior portion of the sixth, seventh, and eighth ribs, as well as the costal margin (Figure 1A). Histopathological examination of the tumor showed that it was a desmoid tumor—a rare, benign, unencapsulated neoplasm with strong infiltrative capability locally and a high rate of recurrence after surgical resection. Currently, Marlex mesh is the most widely used material, because it is easy to handle, permeable, highly resistant, durable, and inexpensive. In addition, it is hardly susceptible to infection. However, in contact with the lung, it causes adhesions and an intense fibrotic reaction hindering possible thoracic reoperations, as well as not providing proper support for the chest wall. The mesh used in our patient (PHYSIOMESH™) is composed of two …