Unusual clinical course, Unusual or unexpected effect of treatment, Diagnostic / therapeutic accidents
Peter A. Fedyshin, Michelle Carey, Shazad L. Shaikh, James W. Klena
Department of Cardiovascular Surgery, Geisinger Community Medical Center, Scranton, PA, USA
Am J Case Rep 2020; 21:e920910
Available online: 2020-01-24
Chest wall reconstruction is sometimes needed after resection of a thoracic malignancy. Various materials and techniques have been utilized to restore stability and integrity to the chest wall. We report what we believe is the first use of a cadaveric Achilles tendon to restore stability and function to the chest wall of a young woman who underwent chest wall resection and right upper lobectomy for a superior sulcus tumor.
CASE REPORT: A 46-year-old woman underwent resection of her first through fourth right ribs in addition to her right upper lobe for a squamous cell superior sulcus tumor. Because it was felt her right scapula provided sufficient coverage of her resultant chest wall defect, her chest wall was not reconstructed post-operatively. The patient experienced 2 episodes of scapular prolapse into her thoracic cavity several months after her resection. After the second episode, her right chest wall was successfully reconstructed with a cadaveric Achilles tendon to prevent further episodes of prolapse.
CONCLUSIONS: We believe this is the first description of chest wall reconstruction with a cadaveric Achilles tendon. The use of a cadaveric Achilles tendon should be considered for reconstruction of the chest wall after complex resection due to its strength characteristics, resistance to subsequent infection, and availability.
Keywords: Allografts, Carcinoma, Non-Small-Cell Lung, Pancoast Syndrome