Chest Wall Reconstruction Using a Methyl Methacrylate Neo-Rib and Mesh

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Chest Wall Reconstruction Using a Methyl Methacrylate Neo-Rib and Mesh Kei Suzuki, MD, Bernard J. Park, MD, Prasad S. Adusumilli, MD, Nabil P. Rizk, MD, James Huang, MD, David R. Jones, MD, Manjit S. Bains, MD The Annals of Thoracic Surgery Volume 100, Issue 2, Pages 744-747 (August 2015) DOI: 10.1016/j.athoracsur.2015.02.127 Copyright © 2015 The Society of Thoracic Surgeons Terms and Conditions

Fig 1 (A) Computed tomography image of our patient, demonstrating a recurrent chondrosarcoma of the anterior right sixth rib (lesion denoted by the white arrow). (B) A large defect in the anterior chest wall is demonstrated after resection of the tumor, measuring approximately 11 × 9 cm (width × height). The Annals of Thoracic Surgery 2015 100, 744-747DOI: (10.1016/j.athoracsur.2015.02.127) Copyright © 2015 The Society of Thoracic Surgeons Terms and Conditions

Fig 2 (A) The Steinmann pin is conformed to the desired shape. (B) The Penrose drain is cut to a length shorter than the Steinmann pin, and the pin is placed through the Penrose drain. (C) The Steinmann pin with Penrose drain is placed in the patient after holes are drilled on each side of the space it will bridge. (D) Methyl methacrylate is injected into the Penrose drain. The Annals of Thoracic Surgery 2015 100, 744-747DOI: (10.1016/j.athoracsur.2015.02.127) Copyright © 2015 The Society of Thoracic Surgeons Terms and Conditions

Fig 3 (A) In order to secure the neo-rib, methylmethacrylate is injected into the previously drilled hole in the manubrium around the Steinmann pin. (B) The Penrose drain is removed, and the construction of the neo-rib is complete. (C) Marlex mesh is secured to the superior native rib. The mesh is wrapped around the neo-rib and sutured to itself with Prolene stitches. The Annals of Thoracic Surgery 2015 100, 744-747DOI: (10.1016/j.athoracsur.2015.02.127) Copyright © 2015 The Society of Thoracic Surgeons Terms and Conditions

Fig 4 The radiolucent neo-rib is seen in this postoperative x-ray film (the neo-rib is denoted by the black arrow). The Annals of Thoracic Surgery 2015 100, 744-747DOI: (10.1016/j.athoracsur.2015.02.127) Copyright © 2015 The Society of Thoracic Surgeons Terms and Conditions