Brustwandrekonstruktion mittels Polypropylennetz: eine monozentrische 8-jährige Analyse

Zusammenfassung

Einleitung Brustwandresektionen für die Behandlung von malignen Erkrankungen benötigen häufig eine Rekonstruktion des Defektes. Wir berichten über unsere monozentrische, 8-jährige Erfahrung in Brustwandrekonstruktion mithilfe eines monofilen Polypropylennetzes. Ziel unserer retrospektiven Analyse war die Erkennung von materialbezogenen Komplikationen und der Vergleich mit der vorhandenen Literatur.

Material und Methoden Einschlusskriterium in unserer retrospektiven Kohorte war eine Brustwandvollexzision und Rekonstruktion mittels Polypropylennetzes bei hauptsächlich onkologischem Indikationsspektrum (z. B. Sarkome, Metastasen, Lungenkarzinome mit Infiltration der Brustwand) im Zeitraum Januar 2008 bis Januar 2017. Primäre Endpunkte waren materialbezogene Komplikationen: lokale Infektion, Serom, Materialmigration, Netzexplantation und Brustwandinstabilität. Sekundäre Endpunkte waren folgende postoperative Komplikationen: Pneumonie, Acute respiratory Distress Syndrome (ARDS), Nachblutung und prolongierte postoperative Beatmung (> 24 h postoperativ).

Ergebnisse In einem Zeitraum von 8 Jahren wurden insgesamt 202 Brustwandresektionen in unserer Klinik durchgeführt. Davon wurden 138 Defekte mithilfe eines Polypropylennetzes rekonstruiert. Mit einer Rate von 12,3% war die Pneumonie die häufigste postoperative Komplikation. In 5,7% der Fälle entwickelte sich ein Wundserom, das die Anlage einer Redon-Sogdrainage notwendig machte. In 3 Fällen (2,1%) wurde eine lokale Wundinfektion mikrobiologisch bestätigt. In einem dieser Fälle musste das Rekonstruktionsmaterial entfernt werden. Die 30-Tage-Mortalität betrug 1,4% mit 2 postoperativen Todesfällen. Eine Materialmigration oder Brustwandinstabilität mit paradoxem Atembewegungsmuster wurden in keinem Fall dokumentiert.

Fazit Die Brustwandrekonstruktion mittels Polypropylen ist eine komplikationsarme Technik. Die hier aufgezeigte niedrige Rate an lokalen Infektionen, Materialexplantationen sowie Brustkorbinstabilität kann ein hilfreicher Entscheidungsfaktor für den operierenden Thoraxchirurgen auf der Suche nach dem geeigneten Rekonstruktionsmaterial sein.

Abstract

Background Chest wall resection for malignant tumours is usually combined with reconstruction of the bony defect. We analysed our single centre, 8-year, experience using polypropylene mesh for chest wall reconstruction. The goal of our retrospective study was to identify material-related complications and to compare them with the existing literature.

Methods The inclusion criterion in our retrospective cohort was a full-thickness chest wall excision and reconstruction using a polypropylene mesh with a mainly oncological indication spectrum (e.g. sarcomas, metastases, lung carcinomas with infiltration of the chest wall) in the period from January 2008 to January 2017. Primary endpoints were material-related complications: local infection, seroma, material migration, mesh explantation and chest wall instability. Secondary endpoints were the following postoperative complications: pneumonia, acute respiratory distress syndrome (ARDS), postoperative bleeding and prolonged postoperative ventilation (> 24 h postoperatively).

Results A total of 202 chest wall resections were performed in our clinic over a period of 8 years. Of these, 138 defects were reconstructed using a polypropylene mesh. Pneumonia was the most common postoperative complication at a rate of 12.3%. In 5.7% of the cases, a wound seroma developed that made it necessary to insert a Redon suction drain. Local wound infection was confirmed microbiologically in three cases (2.1%). In one of these cases, the reconstruction material had to be removed. The 30-day mortality rate was 1.4% with two postoperative deaths. Material migration or chest wall instability with a paradoxical pattern of breathing movement were not documented.

Conclusion Chest wall reconstruction using polypropylene mesh is a technique with low material-related complication rate. The low rate of local infections, material explantation, and chest instability documented in our cohort can be a helpful decision factor for the operating thoracic surgeon looking for the appropriate reconstruction material.

Schlüsselwörter

Brustwand - Rekonstruktion - Polypropylen - Netz

Key words

chest wall - reconstruction - polypropylene - mesh

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