Chest Wall Reconstruction Using a Titanium Mesh Plate and an Expanded Polytetrafluoroethylene Sheet: A Case Report.

Abstract

<h4>Introduction</h4>The integrity and stability of the chest wall (CW) are major factors that ensure the protection of the thoracic organs and proper respiratory function. In cases requiring extensive CW resection for tumor control, reconstruction using autologous tissue or synthetic materials is often performed. However, the optimal approach remains undetermined. We report a case of successful CW reconstruction using a combination of a titanium mesh plate and a dual-surface expanded polytetrafluoroethylene (ePTFE) sheet.<h4>Case presentation</h4>A man in his 70s presented for referral with a CW tumor in the left anterior chest. The tumor was located in the left anterior CW and was suspected to have pulmonary, thymic, and pectoralis major and minor invasions. Surgical resection included removal of the 2nd through the 4th ribs, partial left upper lobectomy, and partial thymectomy. The large CW defect was reconstructed via rigid reconstruction using a titanium mesh plate with a dual-mesh ePTFE sheet sewn inside. Pathological examination revealed a sarcomatoid malignant pleural mesothelioma. Three years after surgery, the patient remained recurrence-free. Despite radiographic evidence of titanium plate cracking, the pulmonary function and thoracic mechanics were preserved.<h4>Conclusions</h4>The combination of ePTFE sheets, which have a smooth surface to protect the lungs and excellent tissue affinity, and titanium mesh plates, which are sufficiently rigid to maintain thoracic function, is an excellent method of rigid reconstruction that takes advantage of the strengths of each material. This technique is feasible and versatile and ensures short-term postoperative stability. Nevertheless, the long-term safety and potential complications warrant further clinical evaluation.