Use of the titanium vertical ribs osteosynthesis system for reconstruction of large posterolateral chest wall defect in lung cancer

We report a case of reconstruction of a large full-thickness posterolateral defect of the chest wall after resection of a stage III non-small cell lung carcinoma (NSCLC) using the combination of a vertical expandable prosthetic titanium device and a polytetrafluoroethylene (PTFE) mesh. A 40-year-old female presented with a NSCLC classified as type IIIA and required both neoadjuvant radiotherapy and chemotherapy. An en bloc resection including the left upper lobe, posterolateral segments of five ribs (K3-K7) and vertebral bodies (T3-T6) was performed through a posterior J-shaped approach. A vertical rib osteosynthesis system was used to ensure thoracic wall stability and mechanical organ protection, prevent ventilatory impairment, avoid incarceration of the tip of the scapula, and maintain an acceptable cosmetic aspect. The device was locked onto the middle arch of the second and eighth ribs. We hung the PTFE mesh from the titanium bars with multiple non-absorbable sutures under maximal tension. Final pathological classification was T4N0M0 with an R0 final resection status. After an uneventful course, the patient was discharged on postoperative day 10. This first experience indicates that vertical rib osteosynthesis combined with a PTFE mesh can be used safely and easily in a one-stage procedure for major posterior chest wall defects. (C) 2011 Published by European Association for Cardio-Thoracic Surgery. All rights reserved.