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StayCurrentMD
Pediatric chest wall reconstruction for osteosarcoma: case-based approach
With Dr. Margaret Mutch · hosted by Lizzy Lee, PA-C
Chapter 2 of 4
Surgical technique
Surgical technique: combined resection and chest wall reconstruction
Cued at 3:14 · press play
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Educational content from recorded physician discussions — not medical advice. Talk to your (or your child's) care team about your situation.
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What the experts said
The team has about 10 years of experience with chest wall reconstructions.
The patient had an incomplete cord injury with absent lower limb reflexes and altered motor and sensation below the level of T6.
The patient underwent emergency posterior laminectomy and partial tumor debulking between the levels of T3 and T7 for cord decompression.
Anterior thoracotomy removed a PET avid lesion that confirmed aggressive osteosarcoma replacing a lymph node.
Most of the reconstruction needs to be tailored to the needs of each individual, location and size of defects.
A lot of the literature on chest wall reconstruction is coming from adults.
Spinal surgeons removed all vertebral bodies between T4 and T7 and inserted a cage, and the thoracic team resected ribs 4 to 7.
During surgery, a tumor thrombus was found in the azygos which extended into the SVC.
The team tends to use resorbable and biosynthetic materials to do the reconstruction.
Two systems are available in Australia for resorbable plates: one by Stryker and one by KLS.
Permacol was placed on top of the implant, and a latissimus dorsi pedicled flap was used to cover the Permacol.
Permacol is made of a porcine dermal collagen matrix.
The delta plates or sonic weld system are polylactide and polyglycolide and polydioxanone plates.
The resorbable plates have a strength of 78% at 2 months and 50% at 6 months.
The patient had a relapse 18 months following the surgery close to his sternum.
The patient is currently having adjuvant chemotherapy.
There was early postoperative infection in one patient which was treated with IV antibiotics.
There were sterile seromas in two patients in the early stages, one at 2 months and one at 8 months.
Radio guided occult lesion localization using technetium 99 was performed.
There is a lack of clear evidence-based guidelines for reconstructive materials.
The priority for reconstruction is long-term durability, aesthetics, function, and accommodating future growth.
Instead of using screws packaged with the plates, they used a K-wire drill to drill through the remaining ribs and proline sutures to secure the implant.
Dr. Matt Nartin performed further chest wall reconstruction excising the entire sternum, costochondral cartilages, and anterior ribs and replaced it with a cement mesh.
Both patients with sterile seromas were treated with IR drainage.
There was one case of minor scoliosis on follow-up, which is being followed by the spinal team and so far has not needed intervention.
Chest wall reconstruction in children is a complex procedure and should be tailored to the individual patient.
Bioengineering of tissue replacement and 3D printing may be the way of the future in chest wall reconstructions.