Resection to restoration: Assessing the synergy of polypropylene mesh (Marlex®) combined with methyl-methacrylate and latissimus dorsi flap for primary chest wall sarcomas

Marco Palmesano; Andrea Lisa; Gabriele Storti; Manuela Bottoni; Alessandra Gottardi; Giulia Colombo; Benedetta Barbieri; Cristina Garusi; Pietro Sala; Giorgio Lo Iacono; Lorenzo Spaggiari; Francesca De Lorenzi; Valerio Cervelli; Mario Rietjens

doi:10.1016/j.bjps.2024.04.022

Resection to restoration: Assessing the synergy of polypropylene mesh (Marlex®) combined with methyl-methacrylate and latissimus dorsi flap for primary chest wall sarcomas

J Plast Reconstr Aesthet Surg. 2024 Apr 15:93:157-162. doi: 10.1016/j.bjps.2024.04.022. Online ahead of print.

Affiliations

¹ Department of Plastic Surgery, University of Rome "Tor Vergata," Viale Oxford 81, Rome, Italy.
² Department of Plastic and Reconstructive Surgery, European Institute of Oncology, IRCCS, 20141 Milan, Italy; Humanitas University Department of Biomedical Sciences, Humanitas University, Via Rita Levi Montalcini 4, Pieve Emanuele, Milan 20090, Italy; PhD Program in Applied Medical-Surgical Sciences, Department of Surgical Sciences, University of Rome "Tor Vergata," Viale Oxford 81, 00133 Rome, Italy.
³ Department of Plastic and Reconstructive Surgery, European Institute of Oncology, IRCCS, 20141 Milan, Italy.
⁴ Department of Thoracic Surgery, IEO, European Institute of Oncology IRCCS, 20141 Milan, Italy.
⁵ Department of Thoracic Surgery, IEO, European Institute of Oncology IRCCS, 20141 Milan, Italy; Department of Oncology and Hemato-Oncology, University of Milan, 20122 Milan, Italy. Electronic address: lorenzo.spaggiari@ieo.it.

PMID: 38691953
DOI: 10.1016/j.bjps.2024.04.022

Abstract

Background: Chest-wall sarcomas are treated with extensive resections and complex defect reconstruction to restore chest-wall integrity. It is a difficult surgical procedure that incorporates a multidisciplinary approach for the best outcome, preventing paradoxical chest movement issues and reducing complications.

Objective: We aimed to describe our experience of chest-wall reconstruction using polypropylene mesh (Marlex® Mesh) combined with methyl-methacrylate and soft-tissue coverage with a latissimus dorsi flap following sarcoma resection.

Patients and methods: Among the 53 patients treated for primary chest-wall sarcomas at the European Institute of Oncology (IEO) in Milan, Italy, from 1998 to 2020, 14 cases underwent chest-wall resection and reconstruction using polypropylene mesh, methyl-methacrylate and the latissimus dorsi flap. Patients with locally advanced breast cancers, locally advanced lung cancers, squamous cell carcinomas, and other secondary chest-wall malignancies were excluded from the study, as were the patients with different types of chest-wall reconstruction.

Results: In this study, 14 patients (6 men and 8 women) with various primary chest-wall sarcomas were enrolled. On an average, 2 ribs (range: 1-5) were removed during the surgeries, and the chest-wall defects ranged from 20 to 150 cm² with an average size of 73 cm². The mean follow-up period for these patients was approximately 63.80 months CONCLUSION: The combination of Marlex® mesh filled with methyl-methacrylate and covered using latissimus dorsi myocutaneous flap provides safe, low-cost and effective single-stage chest-wall reconstruction after surgery for primary sarcomas.

Keywords: Chest wall; Latissimus dorsi; Paradoxical movements; Sarcomas.