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• W1996133036 abstract "Anterior chest wall resections may significantly alter the respiratory physiology depending on whether the entire sternum is involved, the size of the defect, and the type of reconstruction.1Rocco G. Chest wall resection and reconstruction according to the principles of biomimesis.Semin Thorac Cardiovasc Surg. 2011; 23: 307-313Abstract Full Text Full Text PDF PubMed Scopus (30) Google Scholar, 2Arnold P.G. Pairolero P.C. Chest-wall reconstruction: An account of 500 consecutive patients.Plast Reconstr Surg. 1996; 98: 804-810Crossref PubMed Scopus (289) Google Scholar Meticulous preoperative planning is necessary to effect radical resection and reconstruction according to the principles of biomimesis.1Rocco G. Chest wall resection and reconstruction according to the principles of biomimesis.Semin Thorac Cardiovasc Surg. 2011; 23: 307-313Abstract Full Text Full Text PDF PubMed Scopus (30) Google Scholar To this end, computed tomography image reconstruction and digital subtraction are increasingly becoming a mandatory adjunct to visualize the extent of the chest wall involvement with special attention to tumor margins. To complete preoperative evaluation of tumors infiltrating the full thickness of the chest wall, a video-assisted thoracoscopic assessment of the inner chest wall can be useful, especially when chest wall recurrences from breast cancer or residual tumor after chemotherapy are to be assessed. Because frozen section is not feasible on bone specimens, up to 4- to 5-cm tumor-free margins should be obtained.1Rocco G. Chest wall resection and reconstruction according to the principles of biomimesis.Semin Thorac Cardiovasc Surg. 2011; 23: 307-313Abstract Full Text Full Text PDF PubMed Scopus (30) Google Scholar Although the decision about reconstructive strategy should be individualized, it is common knowledge that the defect resulting from the removal of only one rib may not necessitate reconstruction. However, anterior one-rib defects (ie, rib 4 or 5) in selected patients may require covering (ie, young athletes) if there is a consistent risk for lung herniation.1Rocco G. Chest wall resection and reconstruction according to the principles of biomimesis.Semin Thorac Cardiovasc Surg. 2011; 23: 307-313Abstract Full Text Full Text PDF PubMed Scopus (30) Google Scholar For malignant primary chest wall tumors, the immediate adjacent ribs should be resected for the corresponding length of the infiltrated segment on tumor-free margins.1Rocco G. Chest wall resection and reconstruction according to the principles of biomimesis.Semin Thorac Cardiovasc Surg. 2011; 23: 307-313Abstract Full Text Full Text PDF PubMed Scopus (30) Google Scholar When the manubrium and one or both clavicles are involved, these can be removed without subsequent reconstruction, yielding acceptable shoulder girdle movement.1Rocco G. Chest wall resection and reconstruction according to the principles of biomimesis.Semin Thorac Cardiovasc Surg. 2011; 23: 307-313Abstract Full Text Full Text PDF PubMed Scopus (30) Google Scholar Time-honored materials for chest wall reconstruction (ie, polypropylene, polyglactin meshes, or methylmethracrylate sandwich [MMM] along with polytetrafluoroethylene [PTFE] patches) are still valuable options albeit new materials (ie, titanium plates, acellular collagen matrix meshes, and cryopreserved homografts) are increasingly being preferred due to resilience to infection and ready incorporation into the host tissues.2Arnold P.G. Pairolero P.C. Chest-wall reconstruction: An account of 500 consecutive patients.Plast Reconstr Surg. 1996; 98: 804-810Crossref PubMed Scopus (289) Google Scholar, 3Rocco G. Overview on current and future materials for chest wall reconstruction.Thorac Surg Clin. 2010; 20: 559-562Abstract Full Text Full Text PDF PubMed Scopus (27) Google Scholar The skin resection should be kept at a safe margin (2-3 cm) from the macroscopically visible tumor edge. When the tumor is ulcerated, the cutaneous incision should be at the same distance from the inflamed area. In no instances, concerns regarding subsequent reconstruction should affect the decision on how much to resect. The muscle layers are divided along an oblique line directed away from the tumor so that the en-bloc specimen resembles a truncated cone (Fig. 1A; Video 1). If possible, subcutaneous fat tissue should be spared as reinforcement for subsequent primary or secondary closure. The dissection is started by scarifying the periosteum of the uninvolved ribs. In the event of multiple local recurrences or a previously radiated area, the costal plane is adhered to elevate the overlying (pectoralis) muscles (Fig. 1B; Video 1). Thereafter, the specimen is suspended caudocranially and divided laterally and medially to identify and divide main vascular supply. In straightforward cases, primary closure is possible by subcutaneous undermining of the wound edges or by using plastic surgery techniques of skin approximation or skin grafts.1Rocco G. Chest wall resection and reconstruction according to the principles of biomimesis.Semin Thorac Cardiovasc Surg. 2011; 23: 307-313Abstract Full Text Full Text PDF PubMed Scopus (30) Google Scholar, 2Arnold P.G. Pairolero P.C. Chest-wall reconstruction: An account of 500 consecutive patients.Plast Reconstr Surg. 1996; 98: 804-810Crossref PubMed Scopus (289) Google Scholar Sizable defects are covered with rotation, transposition, and interposition myocutaneous flaps.2Arnold P.G. Pairolero P.C. Chest-wall reconstruction: An account of 500 consecutive patients.Plast Reconstr Surg. 1996; 98: 804-810Crossref PubMed Scopus (289) Google Scholar My preference goes to the V–Y advancement flap, which enables the surgeon to cover extensive anterolateral defects and permits adequate approximation of the donor wound edges.4Rocco G. Scognamiglio F. Fazioli F. et al.V-Y latissimus dorsi flap for coverage of anterior chest wall defects after resection of recurrent chest wall chondrosarcoma.J Thorac Cardiovasc Surg. 2009; 138: 1242-1243Abstract Full Text Full Text PDF PubMed Scopus (5) Google Scholar A triangular-shaped skin island based on the elevated latissimus dorsi is rotated anteriorly (Fig. 2A; Video 1).4Rocco G. Scognamiglio F. Fazioli F. et al.V-Y latissimus dorsi flap for coverage of anterior chest wall defects after resection of recurrent chest wall chondrosarcoma.J Thorac Cardiovasc Surg. 2009; 138: 1242-1243Abstract Full Text Full Text PDF PubMed Scopus (5) Google Scholar Layer-to-layer suturing with polyglactin 2-0 or 3-0 sutures (ie, latissimus dorsi edges to surrounding muscle in the recipient area) is usually sufficient to maintain the flap in place without anchoring it to the underlying ribs.4Rocco G. Scognamiglio F. Fazioli F. et al.V-Y latissimus dorsi flap for coverage of anterior chest wall defects after resection of recurrent chest wall chondrosarcoma.J Thorac Cardiovasc Surg. 2009; 138: 1242-1243Abstract Full Text Full Text PDF PubMed Scopus (5) Google Scholar Alternatively, when the skin is spared to permit a primary closure of the partial thickdness defect, a latissimus dorsi flap can be raised and rotated anteriorly (Fig. 2B; Video 1). Needless to say, these muscle or myocutaneous flaps can be also transposed to cover full-thickness defects. The uppermost intercostal space is opened by electrocautery, keeping it in contact with the superior border of the highest rib to be removed (Fig. 3; Video 1). Once the lowest rib to be removed is identified, the intercostal space is opened by electrocautery along the superior border of the immediately inferior rib. Finger palpation or thoracoscopic exploration of the inner chest wall may contribute to the definition of the resection margins. The intercostal vessels are ligated and divided at the ribs both above and below the involved one or ones (Fig.3; Video 1). By performing anterior and posterior costotomies, bony segments of sufficient length to ensure tumor-free margins are resected along with the corresponding intercostal muscles (Fig. 3; Video 1). As a rule, a material with enough rigidity to ensure chest wall stability needs to be selected. In this setting, PTFE and MMM have proved to serve this purpose.5Weyant M.J. Bains M.S. Venkatraman E. et al.Results of chest wall resection and reconstruction with and without rigid prosthesis.Ann Thorac Surg. 2006; 81: 279-285Abstract Full Text Full Text PDF PubMed Scopus (222) Google Scholar, 6Deschamps C. Tirnaksiz B.M. Darbandi R. et al.Early and long-term results of prosthetic chest wall reconstruction.J Thorac Cardiovasc Surg. 1999; 117: 588-591Abstract Full Text Full Text PDF PubMed Scopus (198) Google Scholar The latter are often used in the event of sternal replacement.1Rocco G. Chest wall resection and reconstruction according to the principles of biomimesis.Semin Thorac Cardiovasc Surg. 2011; 23: 307-313Abstract Full Text Full Text PDF PubMed Scopus (30) Google Scholar, 2Arnold P.G. Pairolero P.C. Chest-wall reconstruction: An account of 500 consecutive patients.Plast Reconstr Surg. 1996; 98: 804-810Crossref PubMed Scopus (289) Google Scholar, 6Deschamps C. Tirnaksiz B.M. Darbandi R. et al.Early and long-term results of prosthetic chest wall reconstruction.J Thorac Cardiovasc Surg. 1999; 117: 588-591Abstract Full Text Full Text PDF PubMed Scopus (198) Google Scholar However, when PTFE is used for extensive anterior chest wall defects requiring rib resection up to the entire lateral aspect of the sternum, the reconstruction will be based on a series of sternal punches going through the sternum to accommodate the anchoring sutures for either the PTFE or the MMM4Rocco G. Scognamiglio F. Fazioli F. et al.V-Y latissimus dorsi flap for coverage of anterior chest wall defects after resection of recurrent chest wall chondrosarcoma.J Thorac Cardiovasc Surg. 2009; 138: 1242-1243Abstract Full Text Full Text PDF PubMed Scopus (5) Google Scholar, 5Weyant M.J. Bains M.S. Venkatraman E. et al.Results of chest wall resection and reconstruction with and without rigid prosthesis.Ann Thorac Surg. 2006; 81: 279-285Abstract Full Text Full Text PDF PubMed Scopus (222) Google Scholar, 6Deschamps C. Tirnaksiz B.M. Darbandi R. et al.Early and long-term results of prosthetic chest wall reconstruction.J Thorac Cardiovasc Surg. 1999; 117: 588-591Abstract Full Text Full Text PDF PubMed Scopus (198) Google Scholar (Video 1). However, titanium plates in association with acellular collagen matrix or cryopreserved homografts could be a viable alternative for reoperations and heavily irradiated areas7Rocco G. Fazioli F. Scognamiglio F. et al.The combination of multiple materials in the creation of an artificial anterior chest cage after extensive demolition for recurrent chondrosarcoma.J Thorac Cardiovasc Surg. 2007; 133: 1112-1114Abstract Full Text Full Text PDF PubMed Scopus (31) Google Scholar (Fig. 4B, C; Video 1). Titanium plates can be molded to fit the rib contour and then cut to the desired length (Fig. 4C; Video 1). The plates are anchored to the bony ribs with titanium screws of increasing length as required by the rib thickness. Usually, 3-4 screws on each side represent sufficient warranty against fracture or dislocation, which in our experience occurred in only one patient, who required plate replacement with acellular collagen matrix patching. Bone drills are of utmost value to guide the precise insertion of the screw (Fig. 4C; Video 1).7Rocco G. Fazioli F. Scognamiglio F. et al.The combination of multiple materials in the creation of an artificial anterior chest cage after extensive demolition for recurrent chondrosarcoma.J Thorac Cardiovasc Surg. 2007; 133: 1112-1114Abstract Full Text Full Text PDF PubMed Scopus (31) Google Scholar Usually, titanium plates are placed with a 2:1 ratio compared to the number of resected ribs. If an acellular collagen matrix prosthesis is selected, the sternal Sweet puncher or a bone drill can be used to facilitate placement of the anchoring sutures (2-0, non-reabsorbable) around the perimeter of the prosthesis (Fig. 4B; Video 1).7Rocco G. Fazioli F. Scognamiglio F. et al.The combination of multiple materials in the creation of an artificial anterior chest cage after extensive demolition for recurrent chondrosarcoma.J Thorac Cardiovasc Surg. 2007; 133: 1112-1114Abstract Full Text Full Text PDF PubMed Scopus (31) Google Scholar A combination of titanium plates and acellular collagen matrix patch can be used; in this case, the central prosthesis is sutured to the plates to confer additional stability7Rocco G. Fazioli F. Scognamiglio F. et al.The combination of multiple materials in the creation of an artificial anterior chest cage after extensive demolition for recurrent chondrosarcoma.J Thorac Cardiovasc Surg. 2007; 133: 1112-1114Abstract Full Text Full Text PDF PubMed Scopus (31) Google Scholar (Fig. 4C). Alternatively, the titanium plates are applied without internal coverage material. If the wound cutaneous layer can be closed primarily, the titanium plates are covered with polyglactin meshes to avoid friction on the overlying skin (Fig. 4D; Video 1). If the sternum needs to be removed, the division of the bony rib starts laterally on the side opposite to the most severely involved by the sternal neoplasm. The width of lateral extension is dictated by the need for safe, tumor-free margins.1Rocco G. Chest wall resection and reconstruction according to the principles of biomimesis.Semin Thorac Cardiovasc Surg. 2011; 23: 307-313Abstract Full Text Full Text PDF PubMed Scopus (30) Google Scholar, 2Arnold P.G. Pairolero P.C. Chest-wall reconstruction: An account of 500 consecutive patients.Plast Reconstr Surg. 1996; 98: 804-810Crossref PubMed Scopus (289) Google Scholar, 7Rocco G. Fazioli F. Scognamiglio F. et al.The combination of multiple materials in the creation of an artificial anterior chest cage after extensive demolition for recurrent chondrosarcoma.J Thorac Cardiovasc Surg. 2007; 133: 1112-1114Abstract Full Text Full Text PDF PubMed Scopus (31) Google Scholar If the tumor infiltrates the body of the sternum symmetrically, the resection is started on the left side and then carried out counterclockwise to the level of the same contralateral rib (in a “U” fashion). In any case, the chondrocostal release is performed up to at least one intercostal space superior to the macroscopic appearance of the tumor.7Rocco G. Fazioli F. Scognamiglio F. et al.The combination of multiple materials in the creation of an artificial anterior chest cage after extensive demolition for recurrent chondrosarcoma.J Thorac Cardiovasc Surg. 2007; 133: 1112-1114Abstract Full Text Full Text PDF PubMed Scopus (31) Google Scholar The mammary vessels are routinely identified and divided. The intercostal pedicle is usually dissected through an extraperiosteal route. However, if the primary tumor is a chondrosarcoma, the periosteum should be included in the specimen because its lymphatics may represent a possible route for local recurrence and metastatic dissemination. As the separation of the sternum from the ribs continues, the specimen is suspended, thereby allowing for visualization of the mediastinum. The adhesions connecting the endothoracic fascia to the pericardial fat are divided. If the manubrium can be spared, it is prepared by blunt dissection and divided with a sternal saw immediately above the second chondrosternal joint. If the tumor involves the upper sternum, the sternotomy incision is carried laterally onto the clavicles configuring a T-shaped incision (Fig. 5A).8Rocco G. de Chiara A.R. Fazioli F. et al.Primary giant clear cell sarcoma (soft tissue malignant melanoma) of the sternum.Ann Thorac Surg. 2009; 87: 1927-1928Abstract Full Text Full Text PDF PubMed Scopus (10) Google Scholar The clavicles are dissected in a subperiosteal plane to avoid injury of the adjacent vessels.8Rocco G. de Chiara A.R. Fazioli F. et al.Primary giant clear cell sarcoma (soft tissue malignant melanoma) of the sternum.Ann Thorac Surg. 2009; 87: 1927-1928Abstract Full Text Full Text PDF PubMed Scopus (10) Google Scholar Finger dissection is needed to break retrosternal ligaments behind the manubrium. The mammary pedicles are usually divided at this point and the clavicles are resected as needed en bloc with the manubrium8Rocco G. de Chiara A.R. Fazioli F. et al.Primary giant clear cell sarcoma (soft tissue malignant melanoma) of the sternum.Ann Thorac Surg. 2009; 87: 1927-1928Abstract Full Text Full Text PDF PubMed Scopus (10) Google Scholar (Fig. 5B). Variable options are available for poststernectomy stabilization.2Arnold P.G. Pairolero P.C. Chest-wall reconstruction: An account of 500 consecutive patients.Plast Reconstr Surg. 1996; 98: 804-810Crossref PubMed Scopus (289) Google Scholar, 3Rocco G. Overview on current and future materials for chest wall reconstruction.Thorac Surg Clin. 2010; 20: 559-562Abstract Full Text Full Text PDF PubMed Scopus (27) Google Scholar, 5Weyant M.J. Bains M.S. Venkatraman E. et al.Results of chest wall resection and reconstruction with and without rigid prosthesis.Ann Thorac Surg. 2006; 81: 279-285Abstract Full Text Full Text PDF PubMed Scopus (222) Google Scholar, 6Deschamps C. Tirnaksiz B.M. Darbandi R. et al.Early and long-term results of prosthetic chest wall reconstruction.J Thorac Cardiovasc Surg. 1999; 117: 588-591Abstract Full Text Full Text PDF PubMed Scopus (198) Google Scholar The selection of the reconstructive material depends on the size of the defect, on previous irradiation or surgery, on concurrent infection, and on whether the manubrium is preserved.1Rocco G. Chest wall resection and reconstruction according to the principles of biomimesis.Semin Thorac Cardiovasc Surg. 2011; 23: 307-313Abstract Full Text Full Text PDF PubMed Scopus (30) Google Scholar, 2Arnold P.G. Pairolero P.C. Chest-wall reconstruction: An account of 500 consecutive patients.Plast Reconstr Surg. 1996; 98: 804-810Crossref PubMed Scopus (289) Google Scholar If the sternum is completely removed up to the clavicles, anterior chest wall stabilization can be achieved by means of PTFE or MMM prostheses. If the manubrium is spared, a neosternum is created by fitting a cryopreserved homograft, (ie, iliac crest7Rocco G. Fazioli F. Scognamiglio F. et al.The combination of multiple materials in the creation of an artificial anterior chest cage after extensive demolition for recurrent chondrosarcoma.J Thorac Cardiovasc Surg. 2007; 133: 1112-1114Abstract Full Text Full Text PDF PubMed Scopus (31) Google Scholar; Fig. 6A). The neosternum is locked into the manubrium with titanium screws.7Rocco G. Fazioli F. Scognamiglio F. et al.The combination of multiple materials in the creation of an artificial anterior chest cage after extensive demolition for recurrent chondrosarcoma.J Thorac Cardiovasc Surg. 2007; 133: 1112-1114Abstract Full Text Full Text PDF PubMed Scopus (31) Google Scholar A drill or a sternal puncher is used to accommodate the non-reabsorbable sutures (2-0 polypropylene) anchoring the MMM sandwiches to the neosternum (Fig. 6A, B).7Rocco G. Fazioli F. Scognamiglio F. et al.The combination of multiple materials in the creation of an artificial anterior chest cage after extensive demolition for recurrent chondrosarcoma.J Thorac Cardiovasc Surg. 2007; 133: 1112-1114Abstract Full Text Full Text PDF PubMed Scopus (31) Google Scholar Other cryopreserved homografts can be used (ie, ribs; Video 1) to bridge the defect after sternectomy. Cryopreserved ribs are fixed to native lateral rib segments through either Kirschner wires or titanium plates. Cryopreserved homografts may require an omental, vascularized bed to facilitate vascular inosculation and progressive incorporation into the host. The same technique is used to protect the mediastinum when titanium plates are selected to bridge the poststernectomy defect (Fig. 6C; Video 1).8Rocco G. de Chiara A.R. Fazioli F. et al.Primary giant clear cell sarcoma (soft tissue malignant melanoma) of the sternum.Ann Thorac Surg. 2009; 87: 1927-1928Abstract Full Text Full Text PDF PubMed Scopus (10) Google Scholar The omentum is preferably raised through an upper midline limited laparotomy and passed under and over the homografts or the titanium plates; alternatively, the omental flap can be split in 2 different layers (Fig. 7A, B; Video 1).8Rocco G. de Chiara A.R. Fazioli F. et al.Primary giant clear cell sarcoma (soft tissue malignant melanoma) of the sternum.Ann Thorac Surg. 2009; 87: 1927-1928Abstract Full Text Full Text PDF PubMed Scopus (10) Google Scholar Omental flaps are secured to surrounding structures with polypropylene 2-0 sutures. A potential alternative to omental flaps is represented by the combination of titanium plates and acellular collagen matrix.1Rocco G. Chest wall resection and reconstruction according to the principles of biomimesis.Semin Thorac Cardiovasc Surg. 2011; 23: 307-313Abstract Full Text Full Text PDF PubMed Scopus (30) Google Scholar, 3Rocco G. Overview on current and future materials for chest wall reconstruction.Thorac Surg Clin. 2010; 20: 559-562Abstract Full Text Full Text PDF PubMed Scopus (27) Google Scholar If the defect is in the lower sternum, rigid stabilization may not be necessary. In this case, it might be sufficient to raise the pectoralis major muscles bilaterally and approximate them on the central line, thus covering the defect with viable tissue (Fig. 8).Figure 7Use of the omental wrap with titanium plates or cryopreserved homografts (ie, cryopreserved ribs) after sternectomy (see text). (A) An omental flap is raised through a limited midline laparotomy and passed behind the titanium plates to cover the mediastinum. (B) The omental flap is folded onto the titanium plates or the homograft, which is then “wrapped” into omentum.View Large Image Figure ViewerDownload Hi-res image Download (PPT)Figure 8Reconstruction after partial sternectomy. Both pectoralis major muscles are elevated to cover the midline defect. No prostheses are needed. The medial edges of the muscles are approximated to provide solid coverage of the defect (“paletot” technique).View Large Image Figure ViewerDownload Hi-res image Download (PPT) Nowadays, a versatile, individualized approach to both primary and redo resections for anterior chest wall tumors is possible thanks to the introduction of improved materials for the subsequent reconstruction.1Rocco G. Chest wall resection and reconstruction according to the principles of biomimesis.Semin Thorac Cardiovasc Surg. 2011; 23: 307-313Abstract Full Text Full Text PDF PubMed Scopus (30) Google Scholar Meticulous technique and adherence to the concept of structural and functional biomimesis represent cardinal tenets to achieve optimal results.1Rocco G. Chest wall resection and reconstruction according to the principles of biomimesis.Semin Thorac Cardiovasc Surg. 2011; 23: 307-313Abstract Full Text Full Text PDF PubMed Scopus (30) Google Scholar In this context, postoperative morbidity is gradually decreasing despite the increasing difficulties offered by complicated patients.1Rocco G. Chest wall resection and reconstruction according to the principles of biomimesis.Semin Thorac Cardiovasc Surg. 2011; 23: 307-313Abstract Full Text Full Text PDF PubMed Scopus (30) Google Scholar However, economic issues must be taken into account when selecting the most adequate material for reconstruction.1Rocco G. Chest wall resection and reconstruction according to the principles of biomimesis.Semin Thorac Cardiovasc Surg. 2011; 23: 307-313Abstract Full Text Full Text PDF PubMed Scopus (30) Google Scholar, 3Rocco G. Overview on current and future materials for chest wall reconstruction.Thorac Surg Clin. 2010; 20: 559-562Abstract Full Text Full Text PDF PubMed Scopus (27) Google Scholar In this setting, time-honored prostheses should still be used when a primary resection is performed on neither a previously irradiated nor an infected surgical site.1Rocco G. Chest wall resection and reconstruction according to the principles of biomimesis.Semin Thorac Cardiovasc Surg. 2011; 23: 307-313Abstract Full Text Full Text PDF PubMed Scopus (30) Google Scholar, 3Rocco G. Overview on current and future materials for chest wall reconstruction.Thorac Surg Clin. 2010; 20: 559-562Abstract Full Text Full Text PDF PubMed Scopus (27) Google Scholar, 9Rocco G. Mori S. Fazioli F. et al.The use of biomaterials for chest wall reconstruction 30 years after radical surgery and radiation.Ann Thorac Surg. 2012; 94: e109-e110Abstract Full Text Full Text PDF PubMed Scopus (16) Google Scholar, 10Rocco G. Fazioli F. La Manna C. et al.Omental flap and titanium plates provide structural stability and protection of the mediastinum after extensive sternocostal resection.Ann Thorac Surg. 2010; 90: e14-e16Abstract Full Text Full Text PDF PubMed Scopus (20) Google Scholar Conversely, redo operations often require a combination of materials in light of the extension of the recurrent tumor.1Rocco G. Chest wall resection and reconstruction according to the principles of biomimesis.Semin Thorac Cardiovasc Surg. 2011; 23: 307-313Abstract Full Text Full Text PDF PubMed Scopus (30) Google Scholar, 3Rocco G. Overview on current and future materials for chest wall reconstruction.Thorac Surg Clin. 2010; 20: 559-562Abstract Full Text Full Text PDF PubMed Scopus (27) Google Scholar, 4Rocco G. Scognamiglio F. Fazioli F. et al.V-Y latissimus dorsi flap for coverage of anterior chest wall defects after resection of recurrent chest wall chondrosarcoma.J Thorac Cardiovasc Surg. 2009; 138: 1242-1243Abstract Full Text Full Text PDF PubMed Scopus (5) Google Scholar Accordingly, an increasing number of reconstructive options for reconstruction after anterior chest wall resection are becoming available. In addition, multidisciplinary expertise should be sought in the event of complex reconstructions.1Rocco G. Chest wall resection and reconstruction according to the principles of biomimesis.Semin Thorac Cardiovasc Surg. 2011; 23: 307-313Abstract Full Text Full Text PDF PubMed Scopus (30) Google Scholar Furthermore, thoracoscopic guidance to chest wall resection could further expand the surgical armamentarium.1Rocco G. Chest wall resection and reconstruction according to the principles of biomimesis.Semin Thorac Cardiovasc Surg. 2011; 23: 307-313Abstract Full Text Full Text PDF PubMed Scopus (30) Google Scholar Therefore, in a fashion similar to the biomolecular revolution for lung cancer management, a “targeted” resection and reconstruction can be planned for patients with anterior chest wall tumors." @default.
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