NUOVE TECNICHE DI RICOSTRUZIONE DOPO RESEZIONE MAGGIORI DELLA PARETE TORACICA MEDIANTE APPLICAZIONE DI PROTESI BIO-COMPATIBILI E CELLULE STAMINALI AUTOLOGHE: DALLA SOSTITUZIONE AL RIMODELLING

Introduction: To evaluate the safety and overall improvement by the use of prosthetic methyl methacrylate rib-like reconstruction after the chest wall major resections. Patients and Methods: We evaluated 20 patients, from January 2004 to December 2011, treated at the Fondazione IRCCS Istituto Nazionale dei Tumori of Milano, with primary or metastatic tumors of the chest wall,who underwent surgery with reconstruction by a methacrylate shield shaped prosthesis on a Marlex mesh (CAST)+ /-myo-cutaneous flap. We collected all the clinical population data, the comorbidities , the integrated treatments, the intra and post-operative data (blood, plasma, albumin, transfusions , amount of drained liquids) and complications. Results: The median follow-up time was 3,7 years and the overall survival was 100% at 1 year, 85% at 2 years and 70% at 5 years. The most important complications after this surgery were the post-operative bleeding and proteins loss with need of blood, plasma and albumin transfusions, the flap ischemia or infection. Conclusion: This rigid prosthetic reconstruction is an anatomic and physiologic system, which could represent the evolution, in chest wall surgery, from simple substitution to armonic rimodelling and allows to get the oncological radicality also in maximal resections , such as hemi-thoracectomy.