A practical strategy for skeletal chest wall reconstruction after resection of malignant chest wall lesions: a single-institution experience.

PURPOSE: No standardized strategy exists for skeletal chest wall reconstruction after the resection of malignant chest wall lesions. We reviewed our single-institution experience with defect-specific material selection and perioperative outcomes.

METHODS

The subjects of this retrospective study were 20 patients who underwent reconstruction after resection of malignant chest wall lesions between January 2014 and June 2025. Procedures were categorized as skeletal chest wall reconstruction or adjacent or combined thoracic structure reconstruction. Defects, materials, margins, complications, recurrence, and survival were analyzed.

RESULTS

Fifteen patients underwent skeletal chest wall reconstruction and five underwent adjacent or combined thoracic structure reconstruction. Polypropylene mesh was used for selected anterior, lateral, or extensive skeletal defects when stable fixation and sufficient soft-tissue coverage were achievable. In the 20-patient cohort, resection margin status was R0 in 11 patients and R1 in 9, recurrence developed in 8, and the median postoperative hospital stay was 12 days. MRSA empyema developed in one patient, requiring open-window thoracostomy, vacuum-assisted closure therapy, and thoracoplasty.

CONCLUSIONS

Skeletal chest wall reconstruction should be individualized according to defect-specific factors. Polypropylene mesh may be feasible for selected defects when adequate fixation, appropriate tension, and sufficient soft-tissue coverage can be achieved. The flowchart is a practical institutional framework rather than a validated algorithm.