Thoracic wall reconstruction with bioabsorbable plates in pediatric malignant thoracic wall tumors

Aim: Childhood malignant chest wall tumors may require extensive surgical resection and reconstruction with musculoskeletal flaps or non-resorbable prosthetic materials. Implant-related complications and scoliosis often occur. This study analyzes the outcomes of chest wall reconstruction using resorbable plates as an alternative approach. Methods: Retrospective review (2007-2015) of patients who underwent resection of malignant primary chest wall tumors in 2 tertiary pediatric centers. Reconstruction was performed using copolymer (L-lactic and glycolic acid) plates, fixed to the ribs and surrounding structures with copolymer screws and/or polyglactin sutures. Results: Eight patients aged 10.6 + 2.6 years were treated. There were no operative complications, and implant removal was not required in any case. Six patients received postoperative radiotherapy. Over follow-up (39.6 months, range 9.4-78), chest wall shape was maintained in all, and there were no radiological artifacts. Three patients developed scoliosis (Cobb 17 degrees-33 degrees), but treatment was needed only in one, who had undergone hemivertebrectomy. There were no cases of local tumor relapse. One patient died because of metastatic spread. Conclusions: Implantation of bioabsorbable L-lactic and glycolic acid copolymer plates with a relatively simple technique provided a rigid, stable reconstruction with only mild mid-/long-term complications. Resorbable plates may be a good alternative for pediatric chest wall reconstruction. Level of evidence: IV. (C) 2017 Elsevier Inc. All rights reserved.