Reconstruction of massive chest wall defect after malignant chest wall mass excision in resource limited setting, a case report

• Published in: International journal of surgery case reports 2024-04, Vol.117, p.109496, Article 109496
• Main Authors: Gebremariyam, Zenebe Teklu, Woldemariam, Samuel Tesfaye, Beyene, Tesfaye Dejene, Baharu, Lensa Million
• Format: Article
• Language: English
• Subjects: Case Report; Chest wall mass; Chest wall reconstruction; Flexible wire; Resource limited setting
• ISSN: 2210-2612; 2210-2612
• DOI: 10.1016/j.ijscr.2024.109496

Chest wall tumors, rare but impactful, constitute less than 2 % of the population and 5 % of thoracic neoplasms. Wide-margin resection is vital, often causing substantial defects necessitating reconstruction. However, in resource-limited settings like sub-Saharan Africa, access to reconstruction materials is limited. We present a successful case of managing a massive chest wall defect using flexible wire and polypropylene mesh in such a context. A 40-year-old male presented with a gradually enlarging anterolateral chest wall mass, diagnosed as low-grade synovial sarcoma. Imaging revealed involvement of the 6th to 11th ribs with compression of the diaphragm and liver. A multidisciplinary team planned wide-margin excision, chest wall reconstruction, and adjuvant chemoradiation. Using a sternal wire bridge and polypropylene mesh, the 25 cm by 15 cm defect was reconstructed, covered with a latissimus dorsi flap. The patient recovered well postoperatively, highlighting the feasibility of innovative approaches in resource-limited settings. Defects larger than 5 cm or involving over 4 ribs require reconstruction to prevent lung herniation and respiratory issues, especially for anteriorolateral defects. Our case featured a 25 by 15 cm anteriorolateral chest wall defect, necessitating rigid reconstruction. Due to resource constraints, we utilized flexible wires and polypropylene mesh, offering a cost-effective solution for managing massive chest wall defects. This case underscores the challenges faced in managing chest wall tumors in resource-constrained regions and emphasizes the importance of innovative solutions for achieving successful outcomes in chest wall reconstruction. •Wide-margin excision ensures tumor-free margins, often causing significant chest wall defects.•Reconstructing chest wall and soft tissues is crucial for positive outcomes.•Resource-limited settings pose challenges due to restricted access to materials like titanium plates, Goretex, and methylmethacrylate.•Effective management of large chest wall defects with wire and polypropylene mesh demonstrates innovative adaptation to resource limitations.