Chest wall reconstruction with strattice in an immunosuppressed patient

Abstract

We report successful reconstruction of a challenging composite chest wall defect in an immunocompromised patient using a biologic mesh. Infection results in significant morbidity and mortality in immunocompromised patients. Thus, reconstruction in this population requires careful selection of appropriate materials to repair the defect. A 26-year-old woman with a cardiac paraganglioma required resection of the heart, portions of the great vessels, several ribs, and a large portion of the sternum, with subsequent orthotopic cardiac transplantation. Titanium plates were used to restore sternal continuity and Strattice was used for chest wall reconstruction. Strattice was selected due to its ability to become incorporated and resist wound infection, to provide stability to the rib cage, and to protect the newly transplanted heart. In our experience, Strattice provides a viable alternative to other biologics and is a safer alternative to synthetic mesh for chest wall reconstruction in immunocompromised patients.

Figure 1

The intraoperative specimen of heart, great vessels, and adjacent structures.

Figure 2

A 10 × 10 cm² chest wall defect after en bloc resection of specimen.

Figure 3

Intraoperative photos showing the biologic mesh secured in place to replace the missing segment of chest wall.

Figure 4

Computed tomographic image shows stable internal reconstruction at 9 months with no fluid collection around the graft.

Figure 5

At 14-month follow-up, the scar is well healed with no signs of infection or dehiscence. A prior keloid on breast and mild keloid from sternotomy incision are present.