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Desmoid tumor is an uncommon form of fibromatosis of extremely rare musculoaponeurotic origin. Most are located in the abdomen, and its location in the chest wall is very rare. Due to its inability to produce metastases it has been considered benign, however, its rapid and aggressive local growth makes the surgical treatment equally aggressive and complete. We present a case of a thoracic wall desmoid tumor in a 40-year-old patient, one year evolution, with rapid and aggressive growth which deforms the anatomy of the thoracic wall. Excision of the tumor and 5 partially costal arches were performed, with subsequent thoracic reconstruction with prosthetic material and dermo-fat flap. Desmoid tumors, in advanced stages, requires multidisciplinary participation. [ABSTRACT FROM AUTHOR]

Los grandes defectos torácicos requieren generalmente procedimientos complejos para su reparación; en la mayoría de los casos es necesaria la combinación de tejidos autólogos y materiales aloplásticos, por lo que constituye un desafío para el cirujano plástico. En nuestra institución los que se presentan suelen ser secundarios a exéresis tumoral, bien de origen primario o secundario. Se dispone de varias opciones reconstructivas para cubrir los amplios defectos resultantes de las amplias escisiones y poder aportar colgajos vascularizados, amplios y voluminosos. A pesar de no disponer en nuestro medio de técnicas avanzadas para el soporte rígido, hemos podido dar cobertura a todos los defectos y se ha garantizado una adecuada estabilidad de la pared torácica. Presentamos cuatro casos tratados por grandes defectos del tórax. Se tuvo como objetivo mostrar la forma en que se realizó la reconstrucción inmediata con la combinación de colgajos miocutáneos y material aloplástico.Reconstruction of large defects of the chest wall frequently requires the use of complex techniques that combines autologous tissues and alloplastic materials, which poses a real challenge for the cosmetic surgeon. Those chest defects that are seen in our institution are secondary to tumor excision, either of primary or of secondary origin. Many reconstructive options are necessary to cover large defects as a result of wide resection of tumors and to supply the defect with large, bulky and well vascularized flaps. Although advanced techniques for rigid support are not available in our conditions, it has been possible to cover all defects and to assure adequate stability of the chest wall. Four cases of large chest defects were presented in this paper. The objective was to show how the immediate reconstruction was carried out by combining autologous flaps and alloplastic materials.

La reconstrucción de la pared torácica exige un amplio conocimiento de las técnicas reconstructivas y un buen plan operatorio. Por una parte es necesario mantener la estabilidad de la caja torácica y por otro proporcionar una buena base para la cobertura dérmica o musculocutánea que confiera buenos resultados funcionales y plásticos. En este trabajo describimos 2 casos clínicos en los que la reconstrucción de la pared torácica anterior se realizó con placas de ácido poli-L-láctico sobre las que se colocaron sendos colgajos musculocutáneos.Chest wall reconstruction requires an extensive knowledge of reconstructive techniques and a good surgical plan. On one hand, it is necessary to maintain stability of the rib cage and, on the other, provide a good foundation for dermal coverage or musculocutaneous flaps which confers good functional and plastic results. In this article we describe 2 cases in which anterior chest wall reconstruction was performed with plates of poly-L-lactic acid, on which were placed the musculocutaneous flaps.

Las lesiones de gran tamaño en el tórax, requieren casi siempre para su reparación plastias complejas, que en algunos casos han de combinar el uso de tejidos autólogos y/o materiales sintéticos. Por tanto, la reconstrucción de la pared torácica supone un desafío desde el punto de vista reconstructivo en el que es fundamental el papel de los cirujanos plásticos. Los grandes defectos torácicos suelen ser secundarios a exéresis tumoral (tumores parietales de origen primario o secundario), infecciones, radionecrosis, traumatismos y malformaciones congénitas. Si bien los principios de la reconstrucción del tórax exigen una escisión amplia de la lesión, desbridamiento de los tejidos desvitalizados o irradiados y control de la infección local, dichas actuaciones no podrían abordarse con seguridad si no dispusiéramos de un amplio arsenal de técnicas reconstructivas, capaces de aportar tejidos sanos y bien vascularizados o voluminosos y amplios en superficie, junto con soportes rígidos mediante materiales aloplásticos. Gracias a estos avances, en la mayoría de los casos conseguimos el objetivo con sólo una intervención, cuando hace unos años necesitábamos varios procedimientos quirúrgicos. Presentamos una muestra variada de la experiencia de nuestro Servicio en el tratamiento de grandes defectos del tórax, en el que resumimos las distintas posibilidades que podemos encontrar en la práctica clínica diaria, y las soluciones que mejor se adaptan a las mismas.Reconstruction of full thickness defects on the chest wall is controversial and require the use of complex techniques that combine autologous tissue and/or alloplastic materials. Thus it is a challenge for plastic surgeons since it needs a suitable and functional reconstruction. The aethiology for these defects include tumoral surgery (primary wall tumors, or recurrences or metastasis), infections, radiation injury, trauma and congenital defects. Otherwise, first surgical treatment require wide resection of the tumor or ischaemic or radiated tissue and control of the infection, but these principles could not be safely faced without the multiple reconstructive techniques that can afford the use of well vascularized, large or bulky tissues to reconstruct this anatomical area in combination with alloplastic materials, in order to give a solid stabilization. Thanks to these advances, we can actually perform our objectives in only one procedure. We present a selection of complex chest wall defects that have been operated in the last years by our surgical team. We will describe the solutions and the results obtained by means of a variety of possible flaps and synthetic materials.

Chest wall reconstruction requires an extensive knowledge of reconstructive techniques and a good surgical plan. On one hand, it is necessary to maintain stability of the rib cage and, on the other, provide a good foundation for dermal coverage or musculocutaneous flaps which confers good functional and plastic results. In this article we describe 2 cases in which anterior chest wall reconstruction was performed with plates of poly-L-lactic acid, on which were placed the musculocutaneous flaps. [ABSTRACT FROM AUTHOR]

Reconstruction of full thickness defects on the chest wall is controversial and require the use of complex techniques that combine autologous tissue and/or alloplastic materials. Thus it is a challenge for plastic surgeons since it needs a suitable and functional reconstruction. The aethiology for these defects include tumoral surgery (primary wall tumors, or recurrences or metastasis), infections, radiation injury, trauma and congenital defects. Otherwise, first surgical treatment require wide resection of the tumor or ischaemic or radiated tissue and control of the infection, but these principles could not be safely faced without the multiple reconstructive techniques that can afford the use of well vascularized, large or bulky tissues to reconstruct this anatomical area in combination with alloplastic materials, in order to give a solid stabilization. Thanks to these advances, we can actually perform our objectives in only one procedure. We present a selection of complex chest wall defects that have been operated in the last years by our surgical team. We will describe the solutions and the results obtained by means of a variety of possible flaps and synthetic materials. [ABSTRACT FROM AUTHOR]

Introduction: Chest wall deformities/defects and chest wall resections, as well as complex rib fractures require reconstruction with various prosthetic materials to ensure the basic functions of the chest wall. Titanium provides many features that make it an ideal material for this surgery. The aim is to present our initial results with this material in several diseases., Material and Methods: From 2008 to 2012, 14 patients were operated on and titanium was used for reconstruction of the chest wall. A total of 7 patients had chest wall tumors, 2 with sternal resection, 4 patients with chest wall deformities/defects and 3 patients with severe rib injury due to traffic accident., Results: The reconstruction was successful in all cases, with early extubation without detecting problems in the functionality of the chest wall at a respiratory level. Patients with chest wall tumors including sternal resections were extubated in the operating room as well as the chest wall deformities. Chest trauma cases were extubated within 24h from internal rib fixation. There were no complications related to the material used and the method of implementation., Conclusions: Titanium is an ideal material for reconstruction of the chest wall in several clinical situations allowing for great versatility and adaptability in different chest wall reconstructions., (Copyright © 2013 AEC. Published by Elsevier Espana. All rights reserved.)