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Surgery of the chest wall is potentially required to cover large defects after  removal of malignant tumours. Usually, inert and non-degradable Gore-Tex serves to replace the missing tissue. However, novel biodegradable materials combined with stem cells are available that stimulate the healing. Based on poly-lactic-co-glycolic acid and amorphous calcium phosphate nanoparticles (PLGA/aCaP) and pure PLGA, a dual layer biodegradable hybrid nanocomposite was generated. Mouse adipose-derived stem cells were cultered on electrospun disks (ASCs of C57BL/6), and biomechanical tests were performed. The cell-seeded scaffolds were engrafted in C57BL/LY5.1 mice to serve as a chest wall substitute. Cell invasion into the bi-layered material, extent of CD45 + cells, inflammatory response, neo-vascularization and ECM composition were determined at 1 and 2 months post-surgery, respectively. The bi-layered hybrid nanocomposite was stable after a 2-week in vitro culture, in contrast to PLGA/aCaP without a PLGA layer. There was a complete biointegration and good vascularization in vivo . The presence of ASCs attracted more CD45 + cells (hematopoietic origin) compared to cell-free scaffolds. Inflammatory reaction was similar for both groups (±ASCs) at 8 weeks. A bi-layered hybrid nanocomposite fabricated of electrospun PLGA/aCaP and a reinforcing layer of pristine PLGA is an ideal scaffold for chest wall reconstruction. It is stable and allows a proper host tissue integration. If ASCs are seeded, they attract more CD45 + cells, supporting the regeneration process.

Thoracoplasty is a procedure to collapse the chest wall over a residual space in the thoracic cavity in order to abolish and avoid the complications associated with this dead space. Although effective in achieving this, the procedure is crippled by poor cosmetic appearance and functional outcome. We report a case of recalcitrant complex chest wall defect with a large cavity, marred by visible heart and poor availability of local muscles, that was successfully managed by a novel technique of thoracoplasty with acceptable postoperative appearance and function.

Ascending thoracic aortic aneurysm (ATAA) pathogenesis varies with aortic valve morphology, yet regional heterogeneity between inner curvature (IC) and outer curvature (OC) remains incompletely characterized. We hypothesized that regional differences between the outer and inner curvature of the ascending aorta are valve-morphology dependent and reflect distinct remodeling mechanisms in bicuspid versus tricuspid aortic valve-associated aortopathy. Ascending aortic tissue from 155 patients (69 tricuspid aortic valve [TAV], 68 bicuspid aortic valve [BAV], 18 non-aneurysmal heart transplantation [HTx] controls) underwent uniaxial tensile testing (n = 66), histological analysis, hydroxyproline assay, and reverse transcription quantitative PCR (RT-qPCR) for collagen (COL1A1, COL3A1, COL4A1, COL5A1, COL11A1) and elastin (ELN) genes. The OC was thinner than the IC in both TAV and BAV (p < 0.001), with no regional differences in HTx. TAV demonstrated increased OC stiffness (E-modulus 0.60 ± 0.31 vs. 0.43 ± 0.24 MPa, p = 0.004) with reduced failure strain (p = 0.013). BAV showed preserved stiffness but reduced OC extensibility (ε_max 56.5 ± 15.1% vs. 72.4 ± 21.7%, p < 0.001). BAV exhibited elevated OC collagen content (hydroxyproline OC/IC ratio 1.42, p = 0.048), whereas TAV showed reduced OC elastin area (p < 0.01). All collagen genes were upregulated at the OC in both TAV (all p < 0.001) and BAV (all p < 0.05), with COL11A1 showing the highest fold change (3.4-fold in TAV). ELN was reduced at the OC in TAV (p < 0.001) but unchanged in BAV. ATAAs exhibit distinct valve-dependent regional heterogeneities. The discordance between collagen gene expression and protein content suggests valve-specific differences in collagen regulation. These findings support distinct pathomechanisms and highlight the limitations of diameter-based risk stratification, motivating further investigation of regional wall assessment as a complement to current size criteria for surgical decision-making.

Background Poland syndrome is a rare congenital chest wall developmental defect. Traditional reconstruction applies open to harvest of the latissimus dorsi muscle flap, but issues like large incisions and high complication rates exist. Endoscopic-assisted harvest of the latissimus dorsi muscle flap has minimally invasive advantages worth exploring for application in Poland syndrome patients. Methods We retrospectively analyzed the surgical situations of five Poland syndrome patients at our center, and systematically searched the literature, including 31 cases of endoscopic-assisted latissimus dorsi muscle flap reconstruction. Data on surgical complications, postoperative shoulder function scores, aesthetic scores, and patient satisfaction were collected and comprehensively analyzed in combination with literature reports. Results Endoscopic surgery had smaller incisions, fewer complications, shorter recovery time, and high patient scar satisfaction. Postoperative aesthetic results were good, but the obtained flap tissue volume was limited. Upper limb function at the donor site was preserved, but there was some degree of strength decline. Conclusions Endoscopic-assisted latissimus dorsi flap surgery (ELDM) allows for clear visualization of the surgical field, reduces complications, minimizes scarring, shortens recovery time, and provides better cosmetic results, making it suitable for young Poland syndrome patients seeking improved aesthetic outcomes. Level of Evidence IV This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors   www.springer.com/00266 .

The purpose of this article is to review closure options for complex chest wounds in patients with locally advanced breast cancer. Experiences of the plastic and oncologic surgery teams at Moffitt Cancer Center were reviewed, and the literature researched for various surgical options of complex chest wound closure. Multiple treatment modalities exist for reconstruction of complex chest wall wounds with the external oblique and V-Y latissimus dorsi musculocutaneous advancement flaps serving as workhorses in reconstruction. Treatment of cancer has moved from simply a surgical solution to include other modalities such as hormonal therapy, chemotherapy, and radiation—the latter 2 having serious consequences for wound healing. A team approach and knowledge of available flap options are vital for closure of complex wounds in a timely manner. Appropriate planning can optimize the primary goal of the oncologic surgeon to remove the cancer and the plastic surgeon’s objective to reconstruct the defect and achieve a closed, durable wound prior to chemotherapy and radiation. We present the experience at the Moffitt Cancer Center in reconstructing challenging chest defects and review the reconstructive ladder.

Background Sarcomas of the trunk and abdominal wall are rare and present unique challenges in both resection with free margins and reconstruction, particularly when the tissue loss is extensive. These tumors predominantly affect young, active individuals, posing a significant challenge for oncologists and plastic surgeons in preserving the patients’ quality of life. Case presentation We present the case of 23-year-old woman with no significant medical history. She was initially treated at a nonexpert center for a monophasic synovial sarcoma of the abdominal wall. After undergoing three lines of chemotherapy with no response, she was referred to our department, a sarcoma expert center, for debulking surgery in October 2020. Physical examination revealed a large, firm, and painful subcutaneous mass located in the left iliac fossa, extending into the flank. This mass was beneath a linear scar from prior enucleation surgery and measured approximately 25 cm. A full body CT scan confirmed that the mass was attached to the anterior abdominal wall, with no evidence of invasion into internal abdominal organs or metastatic spread. Because of the large size of the tumor and the consequent full-thickness defect of the anterior abdominal wall, surgical resectability depends on the success of the reconstructive surgery. Given the large tumor size and resulting full-thickness defect of the abdominal wall, the success of the surgical resection heavily relies on the effectiveness of the reconstructive surgery. We successfully performed a two-stage intervention, starting with a laced latissimus dorsi (LD) free flap transfer, followed by oncological resection seven days later. While this technique has been described for head and neck reconstruction, it is, to our knowledge, the first reported use in abdominal wall reconstruction. Conclusions Surgical resection remains the cornerstone of treatment for synovial sarcoma, and the extent of resection should not be limited by concerns about defect restoration. The free latissimus dorsi flap, when utilized with careful surgical planning, is an effective option for reconstructing complex abdominal wall defects. This case highlights the importance of advanced reconstructive techniques in ensuring both oncological control and the preservation of the patient quality of life.

Introduction When planning for breast augmentation, it is important to consider not only implant choice, surgical technique and patient desires, but also the chest wall shape and deformities or irregularities, which remain often underestimated. They can be responsible for implant malposition and breast asymmetry after augmentation. Chondrocostal junction prominence is a minor but frequent chest wall deformity. The aim of this study is to report a new technique for sculpturing isolated chondrocostal prominence deformities in patients undergoing breast augmentation. Methods A retrospective study was conducted to review surgical outcomes of a novel technique for costal prominence sculpturing and reshaping in patients undergoing breast augmentation. After reaching the subpectoral space, an inferiorly-based perichondral–periosteal flap is harvested just above the prominence. Once the deformity is corrected, the perichondral flap is repositioned over the sculpted rib. Results A total of six patients presenting with isolated chondrocostal prominence underwent bilateral breast implant placement and costal reduction using the described technique. Three patients were primary augmentations while the remaining patients were two secondary breast augmentation and one augmentation mastopexy. No complications were reported. No additional pain was referred at the side of rib remodelling in comparison with the contralateral breast. All the patients were satisfied with cosmetic results. Conclusions The described technique for contouring of isolated chondrocostal deformities is fast, easy reproducible and offers advantages over the standard partial rib reduction technique. It can prevent implant malposition and projection asymmetry, eventually enhancing breast augmentation outcomes. Level of Evidence V This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

Purpose Multi-level reconstruction incorporating the chest wall and ribs is technically demanding after multi-segmental total en bloc spondylectomy (TES) of thoracic spinal tumours. Few surgical techniques are reported for effective reconstruction. A novel and straightforward technical reconstruction through posterior-lateral approach was presented to solve the extensive chest wall defect and prevent occurrences of severe respiratory dysfunctions after performing TES. The preliminary outcomes of surgery were reviewed. Methods Multi-level TES was performed for five patients with primary or recurrent thoracic spinal malignancies through posterior-lateral approach. The involved ribs and chest wall were removed to achieve tumour-free margin. Then titanium mesh with allograft bone and pedicle screw-rod system were adopted for the circumferential spinal reconstruction routinely. Titanium rods were modified accordingly to attach to the screw-rod system proximally, and the distal end of rods was dynamically inserted into the ribs. Results The mean surgery time was 6.7 hours (range 5–8), with the average blood loss of 3260 ml (range 2300–4500). No severe neurological complications were reported while three patients had complaints of slight numbness of chest skin (no. 1, 3, and 5). No severe respiratory complications occurred during peri-operative period. No implant failure and no local recurrence or distant metastases were observed with an average follow-up of 12.5 months. Conclusions The single-stage reconstructions incorporating spine and chest wall are straightforward and easy to perform. The preliminary outcomes of co-reconstructions are promising and favourable. More studies and longer follow-up are required to validate this technique.

In patients with ascending aortic (AA) aneurysms, prosthetic graft replacement yields benefit but risk for complications in the descending aorta persists. Longitudinal impact of AA grafts on native descending aortic physiology is poorly understood. Transthoracic echocardiograms (echo) in patients undergoing AA elective surgical grafting were analyzed: Descending aortic deformation indices included global circumferential strain (GCS), time to peak (TTP) strain, and fractional area change (FAC). Computed tomography (CT) was used to assess aortic wall thickness and calcification. 46 patients undergoing AA grafting were studied; 65% had congenital or genetically-associated AA (30% bicuspid valve, 22% Marfan, 13% other): After grafting (6.4±7.5 months), native descending aortic distension increased, irrespective of whether assessed based on circumferential strain or area-based methods (both p<0.001). Increased distensibility paralleled altered kinetics, as evidenced by decreased time to peak strain (p = 0.01) and increased velocity (p = 0.002). Augmented distensibility and flow velocity occurred despite similar pre- and post-graft blood pressure and medications (all p = NS), and was independent of pre-surgical aortic regurgitation or change in left ventricular stroke volume (both p = NS). Magnitude of change in GCS and FAC was 5-10 fold greater among patients with congenital or genetically associated AA vs. degenerative AA (p<0.001), paralleling larger descending aortic size, greater wall thickness, and higher prevalence of calcific atherosclerotic plaque in the degenerative group (all p<0.05). In multivariate analysis, congenital/genetically associated AA etiology conferred a 4-fold increment in magnitude of augmented native descending aortic strain after proximal grafting (B = 4.19 [CI 1.6, 6.8]; p = 0.002) independent of age and descending aortic size. Prosthetic graft replacement of the ascending aorta increases magnitude and rapidity of distal aortic distension. Graft effects are greatest with congenital or genetically associated AA, providing a potential mechanism for increased energy transmission to the native descending aorta and adverse post-surgical aortic remodeling.

Background There are various reconstructive methods after total sternectomy. Reproducibility is scarce due to overall small patient numbers. Therefore we present a standardized, interdisciplinary approach for thoracic and plastic surgery. Methods Four patients underwent interdisciplinary chest wall reconstruction with STRATOS® titanium bars and myocutaneous vastus lateralis muscle free flap in our center. Results All patients reported chest wall stability after reconstruction. They reported good quality of life, no dyspnea, prolonged pain or impairment in lung function from rigid reconstruction. FEV1/FVC was overall better after surgery. Secondary wound healing was not impaired and there was no implant defect in follow up. Conclusions We recommend an interdisciplinary surgical approach in chest wall reconstruction after total sternectomy. The combination of rigid reconstruction with titanium bars and a myocutaneous vastus lateralis muscle free flap renders excellent results in patient satisfaction and is objectifiable via spirometry.