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Reconstruction of the thoracic wall—long-term follow-up including pulmonary function tests

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Abstract

Purpose

Thoracic wall reconstructions have become a standard procedure for the reconstructive plastic surgeon in the larger hospital setting, but detailed reports about long-term results including pulmonary function and physical examination are rare.

Materials and methods

The data of 92 consecutive patients with full thickness chest wall resections were acquired from patient’s charts and contact to patients, their relatives or general practitioners, with special reference to treatment and clinical course. At a mean follow-up of 5.5 years, 36 patients were examined physically and interviewed. Twenty-seven of them underwent additional pulmonary function tests. Kaplan–Meier method was used to calculate survival. Regression tests were undertaken to identify factors influencing the outcome.

Results

Postoperative complications were observed in 42.4%, but neither mesh implantation nor the size of the defect contributed significantly. The 5-year mortality was worse for patients with recurrent mamma carcinoma (90.6%) than for patients with soft tissue sarcoma (56.3%). No medical history or operation parameter (resection size and localization) besides the general patients’ conditions increased mortality. Pulmonary function parameters were only moderately reduced and not significantly affected by the resections’ size or its localization. Majority of patients suffer from sensation disorders and motion-dependent pain, which contributed significantly to hypoxemia. Quality-of-life parameters were significantly reduced compared to the healthy control group but similar to the control group with cancer according to the Short Form-36 protocol. We could not detect a relevant decrease in quality of life comparing post- to preoperative values.

Conclusions

Thoracic wall reconstruction provides sufficient thoracic wall stability to maintain pulmonary function, but postoperative pain and sensation disorders are considerable. However, chest wall repair can contribute to palliation and even cure after full-thickness resections.

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Acknowledgments

We thank the Department of physical therapy of BG-University Hospital Bergmannsheil Bochum, namely, Petra Ostheide who was very helpful in performing the dynamometer measurements, the Department of Biometry and Epidemiology, Ruhr-University, Bochum, R. Klaaßen-Mielke for assistance with statistical analysis, and Amanda Daigeler for her formal English revision of the manuscript.

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Authors and Affiliations

  1. Department of Plastic Surgery, Burn Center, Hand surgery, Sarcoma Reference Center, BG University Hospital Bergmannsheil, Ruhr-University Bochum, Buerkle-de-la-Camp-Platz 1, 44789, Bochum, Germany

    Adrien Daigeler, Daniel Druecke, Mitra Hakimi, Ole Goertz, Heinz-Herbert Homann, Marcus Lehnhardt & Hans-Ulrich Steinau

  2. Department of Internal Medicine, Division of Pneumology, Allergology and Sleep Medicine, Medical Clinic III, BG University Hospital Bergmannsheil, Ruhr-University Bochum, Buerkle-de-la-Camp-Platz 1, 44789, Bochum, Germany

    Hans-Werner Duchna

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  1. Adrien Daigeler
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  2. Daniel Druecke
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Corresponding author

Correspondence to Adrien Daigeler.

Additional information

Adrien Daigeler and Daniel Druecke contributed equally to this study.

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Daigeler, A., Druecke, D., Hakimi, M. et al. Reconstruction of the thoracic wall—long-term follow-up including pulmonary function tests. Langenbecks Arch Surg 394, 705–715 (2009). https://doi.org/10.1007/s00423-008-0400-9

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  • DOI: https://doi.org/10.1007/s00423-008-0400-9

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