Y. H. YOON333
preparation and adaptation to the shape of the defect [1].
Coonar et al. have reported on the advan tages of titanium,
including a high strength-to-weight ratio, osseointegra-
tion, and less interference with computed tomography
than higher density metals have. A reduced rate of com-
puted tomographic artifacts allows for more accurate
three-dimensional reconstructions. Titanium is not fer-
romagnetic, so it can be used safely with magnetic reso-
nance imaging [8]. In 1997, Nomori et al. performed
chest wall reconstruction with a titanium hollow screw
plate in a patient with squamous cell carcinoma invading
the 2th-4th ribs [9]. The defected 3rd and 4th ribs were re-
constructed with rib-to-rib titanium plates. At that time,
meshes, such as PTFE patches, metal plates, and silastic
sheeting were popular with reconstructing huge chest
wall defects. We suspect those types of reconstructions
presented very challenging trials, since there were no
other published reports of titanium plate use in chest wall
reconstruction for more than 10 years. In the past 2 years,
a few excellent cases reports were published. Gonfiotti et al.
operated on a Ewing’s sarcoma patient: two STRATOS
(Strasburg Thoracic Osteosyntheses System; MedXpert,
Heitersheim, Germany) bars were fixed posteriorly to the
ribs, with the special clips, and anterioly to the edges of
the sternum, with metal wires [1]. Bille et al. operated on
a Ewing’s sarcoma patient with a Gore-tex mesh and
titanium rib prosthesis to reconstruc t the third, fourth and
fifth ribs (Stratos) [7]. Coonar et al. placed four STRATOS
titanium plates, fixed by clips to both sides of ribs. Dur-
ing the 21-month follow-up, there was no recurrence;
also demonstrated were the durability and resistance of
inserted titanium plates through scapular and elbow frac-
tures [8,10]. Iarussi et al. performed 13 chest wall recon-
structions using Synthes titanium plates (Synthes, West
Chester, Pa) but no details were published [11]; even
though they achieved chest cage stability, with only 1
titanium plate insertion in the resected area of the 2nd rib.
Just how this stability was achieved has not been dis-
cussed.
Compared to other reported cases, our patient had a
very large mass; for that reason, extensive reconstruction
from the clavicle to the 3rd rib was performed. Instead of
screws and wires, simpler and more relevant material,
such as clips, likely make it easier to fix plates. We used
titanium plates for the first time for a large chest wall
construction, and we had no difficulty inserting the plates
and we easily understood how they work. We assume
that Titanium plates cause less severe adhesions than
other rigid and non-rigid prostheses. Titanium plate chest
wall reconstruction is not used worldwide but has been
performed in some European countries. To establish the
most effective and optimal procedure, long-term follow
up and multicenter studies will be necessary. Titanium
rib plate is suitable in chest wall reconstruction surgery
for large defect chest walls and facilitates a good quality
of life.
Comparisons between titanium plates and other meth-
ods for cost-effectiven ess, quality of life, convenience of
skill, recurrence rate, and mortality sh ould be analyzed in
near future.
5. Conclusions
Titanium rib plate is suitable in chest wall reconstru ction
surgery for huge defect chest walls and facilitates a good
quality of life.
6. Acknowledgements
This work was supported b y an Inha Univ ersity Research
Gant.
7. References
[1] A. Gonfiotti, P. F. Santini, D. Campanacci, et al., “Malig-
nant Primary Chest-Wall Tumors: Techniques of Recon-
struction and Survival,” European Journal of Cardio-
Thoracic Su rgery , Vol. 38, No. 1, 2010, pp. 39-45.
doi:10.1016/j.ejcts.2009.12.046
[2] B. R. LeRoux and D. M. Shama, “Resection of Tumors of
the Chest Wall,” Current Problems in Surgery, Vol. 20,
No. 6, 1983, pp. 345-386.
doi:10.1016/S0011-3840(83)80007-0
[3] H. Horio, T. Ohtshka, Y. Kubota, T. Hasegwa, H. No-
mori, T. Naruke and K. Suemasu, “Large Chest Wall
Resconstruction Using Titanium Micromesh and Pedicled
Lastissimus Dorsi Muscularcutaneous Flap: Report of a
Case,” Surgery Today, Vol. 35, No. 1, 2005, pp. 73-75.
doi:10.1007/s00595-004-2868-4
[4] N.C. Dang, S. Siegel and J. D. Philips, “Malignant Chest
Wall Tumors in Children and Young Adults,” Journal of
Pediatric Surgery, Vol. 34, No. 12, 1999, pp. 1773-1778.
doi:10.1016/S0022-3468(99)90310-X
[5] Mansour K. A., Thourani V. H., Losken A., Reeves J. G.,
Miller J. I. and Jones G. E., Chest wall resection and re-
construction: a 25-year experience. The Annals of Tho-
racic Surgery, Vol. 73, No. 6, 2002, pp. 1720-1725.
doi:10.1016/S0003-4975(02)03527-0
[6] P. G. Arnold and P. C. Pairolero, “Chest-Wall Recon-
struction: An Account of 500 Consecutive Patients,”
Plastic and Reconstructive Surgery, Vol. 98, No. 5, 1996,
pp. 804-810. doi:10.1097/00006534-199610000-00008
[7] A. Bille, M. Gisabella, L. Errico and P. Borasio, “A Suit-
able System of Reconstruction with Titanium Rib Pros-
thesis after Chest Wall Resection for Ewing Sarcoma,”
Interactive CardioVascular and Thoracic Surgery, Vol.
12, No. 2, 2011, pp. 293-296.
doi:10.1510/icvts.2010.245902
Copyright © 2011 SciRes. SS