According to a nation-based study, we intend to report the data of the patients operated on for lung cancer invading the chest wall, taking into consideration the completion of induction chemotherapy (Ind_CT), induction radiochemotherapy (Ind_RCT) or no induction therapy (0_Ind).
All patients with a primary lung cancer invading the chest wall who underwent radical resection from 2004 to 2019 were included. Superior sulcus tumors were excluded.
Overall, 688 patients were included: 522 operated without induction therapy, 101 with Ind_CT and 65 with Ind_RCT. Postoperative 90-day mortality was 10.7% in the 0_Ind group, 5.0% in the Ind_CT group, 7.7% in the Ind_RCT group (p = 0.17). Incomplete resection rate was 14.0% in the 0_Ind group, 6.9% in the Ind_CT group, 6.2% in the Ind_RCT group (p = 0.04). In the 0_Ind group, 70% of the patients received adjuvant therapies. Overall survival (OS) analysis disclosed the best long-term outcomes in the Ind_RCT group (5-year OS probability: 56.5% versus 40.0% and 40.5% for 0_Ind and Ind_CT groups, respectively; p = 0.035). At multivariable analysis, Ind_RCT (HR = 0.571; p = 0.008), age > 60 years old (HR = 1,373; p = 0.005), male sex (HR = 1.710; p < 0.001), pneumonectomy (HR = 1.368; p = 0.025), pN2 status (HR = 1.981; p < 0.001), ≥3 resected ribs (HR = 1.329; p = 0.019), incomplete resection (HR = 2.284; p < 0.001) and lack of adjuvant therapy (HR = 1.959; p < 0.001) were associated with OS. Ind_CT was not associated with survival (HR = 0.848; p = 0.257).
Induction chemoradiation therapy seems to improve survival. Therefore, the present results should be confirmed by a prospective randomized trial testing the benefit of induction radiochemotherapy for NSCLC invading the chest wall.

BACKGROUND: Chest wall reconstruction was introduced for the management of patients with severe chest wall injuries. We undertook a retrospective cohort study to investigate whether the treatment was associated with improved survival compared with conservative treatment.
METHODS: A retrospective single institutional cohort study compared mortality following treatment of major chest wall trauma (Abbreviated Injury Scale ≥3) by chest wall reconstruction (CWR) to conservative management (Non-CWR) between September 2014 and December 2019. Univariable and multivariable associations between demographic and comorbid characteristics and mortality were estimated using Cox proportional hazard analysis and expressed as hazard ratios (HR) and corresponding confidence intervals (CI).
RESULTS: Of a cohort of 947, CWR (n=157, 16.6%) had a lower prevalence of polytrauma (35.7 vs 56.3%, p<0.001) and head injury (11.5% vs 26.7%, p<0.001). CWR-treated patients experienced a greater number of fractured ribs, (8.3 vs 5.8, p<0.001), higher incidence of flail chest (84.9% vs 48.9%, p<0.001), higher admission to Critical Care (64.3% vs 44.1%, p<0.001), greater demand for ventilation (36.9% vs 25.6%, p=0.004) and a higher New Injury Severity Scale value (36.9 vs 34.6, p=0.003). Mortality of CWR patients was significantly lower (3.8% vs 8.6%, p=0.04), with adjusted HR 0.30 (95% CI 0.12, 0.72, p=0.008).
CONCLUSIONS: Chest wall reconstructive surgery, provided as a part of multidisciplinary treatment strategy for major thoracic trauma, reduces risk of mortality. The results validate the UK Government strategy, designed to reduce mortality, by centralising management of serious trauma in Major Trauma Centres.

Objective: We aimed to quantitatively study the characteristic of diaphragm and chest wall motion using free-breathing dynamic magnetic resonance imaging (D-MRI) in Chinese people with normal lung function. Methods: 74 male subjects (mean age, 37 ± 11 years old) were prospectively enrolled, and they underwent high-resolution CT(HRCT), pulmonary functional tests (PFTs), and D-MRI in the same day. D-MRI was acquired with a gradient-echo sequence during the quiet and deep breathing. The motion of the diaphragm and chest wall were respectively assessed by measuring thoracic anteroposterior diameter (AP), left−right diameter (LR), cranial−caudal diameter (CC), and thoracic area ratios between end-inspiration and end-expiration. The effect of age, body mass index (BMI), and smoking on respiratory muscle function was also analyzed. Results: The mean ratio of right and left AP was greater than that of LR on three transversal planes during both quiet and deep breathing. The mean ratio at the anterior diaphragm (AND, Quiet: 1.04 ± 0.03; Deep: 1.15 ± 0.09) was weaker than that of the apex (vs. APD, Quiet: 1.08 ± 0.05, p < 0.001; Deep: 1.29 ± 0.12, p < 0.001) and posterior diaphragm (vs. POD, Quiet: 1.09 ± 0.04, p < 0.001; Deep: 1.30 ± 0.12, p < 0.001) both in quiet and deep breathing. Compared with non-smokers, the left AP and thoracic area ratios in smokers were significantly decreased (p < 0.05). However, the ratios of AP, LR, CC, and thoracic area on each plane were similar among groups in different age and BMI. Conclusions: During both quiet and deep breathing, the chest wall motion is prominent in the anteroposterior direction. The motions of diaphragm apex and posterior diaphragm were more prominent than that of the anterior diaphragm. Smoking may affect the respiratory muscle mobility. Dynamic MRI can quantitatively evaluate the motion of respiratory muscles.

UNASSIGNED: During surgery for spontaneous pneumothorax, parietal pleural small holes (PPSHs) are occasionally found around the apex of the intrapleural space; however, this has not been well recognized. Additionally, chest wall flatness is usually observed in patients with primary spontaneous pneumothorax (PSP) and PPSHs. This study aimed to investigate the prevalence of PPSH and evaluate the characteristics of patients with PPSH. We also investigated the degree of chest wall flatness in patients with PPSHs.
UNASSIGNED: We retrospectively reviewed all patients who underwent thoracoscopic surgery for pneumothorax at our department between April 2014 and May 2021. A propensity-matched analysis was used to compare the characteristics of patients with and without PPSH.
UNASSIGNED: A total of 490 patients were enrolled in this study. PPSH was found in 45 of 297 (15.2%) patients with PSP and one of 193 (0.5%) patients with secondary pneumothorax. PSP was independently associated with the presence of PPSH after adjusting for age and sex [primary/secondary, odds ratio (OR) =34.3, 95% confidence interval (CI): 4.7-250.9; P<0.001]. Among patients with PSP, the flatness of the chest wall in patients with PPSH was not as severe as that in patients without PPSH {thoracic anteroposterior diameter (APDT) to transverse diameter (TDT) ratio; with PPSH: median =0.517 [interquartile range (IQR) =0.480-0.554] vs. without PPSH: median =0.487 (IQR =0.463-0.529; P=0.031)} after propensity score matching.
UNASSIGNED: PPSH is found in a non-negligible proportion of patients with PSP, and patients with PPSHs show a relatively mild flat chest among patients with PSP. Clinicians should be aware of PPSH, and further understanding of this condition may contribute to a better understanding of PSP.

UNASSIGNED: Implant-based reconstruction represents the most common form of breast reconstruction after mastectomy. Although the complication rate has lowered owing to the current advances, various implant-related complications are still a problem. There have been few reports discussing chest wall deformation following implant insertion. The aim of this study was to quantify chest wall depression (CWD) after breast implant insertion and identify possible risk factors.
UNASSIGNED: Patients who underwent unilateral direct-to-implant reconstruction were included in the study. We measured the pre- and postoperative antero-posterior length of the chest wall and used a CWD ratio to measure the change in length. Multivariate analysis was performed with factors with P values of <0.2 in univariate analyses to identify factors associated with CWD.
UNASSIGNED: A total of 57 patients were included in this study. The pre- and postoperative difference of antero-posterior length was statistically significant using a paired t-test. Average depth of CWD was 4.16 mm (range, -2.16 to 13.82 mm). In multivariate analysis, capsular contracture and age were the independent prognostic factors correlated with CWD.
UNASSIGNED: This study showed the possibility of CWD following implant insertion. Surgeons and specialists should be aware of the possibility and risk factors of CWD following implant insertion to better inform patients.

UNASSIGNED: This study aimed to investigate the specific effects of subcutaneous adipose tissue thickness (SATT) on trauma-related injury (TRI) development in patients with low-energy isolated blunt thoracic trauma.
UNASSIGNED: This prospective observational study was performed between March 2018-March 2019. Patients admitted to our hospital because of blunt thoracic trauma were enrolled. SATT in axial CT images of the thorax was measured using the four anatomically designated localizations. Patients were analyzed in terms of demographic data, BMI, comorbid diseases, causes of injury, vital parameters, visual analog scale, trauma score, injury type, treatment, and hospitalization. A poor clinical outcome was defined as the development of a TRI.
UNASSIGNED: The study group consisted of 152 patients (43 female, 109 male). The mean age was 49 ± 19.1 years. There was a positive linear association between the BMI and SATT for all the patients in the study. TRI frequency was higher in the low-SATT subgroup than in the high-SATT group (p < 0.001). BMI and mean SATT values were related to a poor logistic regression analysis outcome (p < 0.01). Being in the low-BMI subgroup was a risk factor for TRI development (p < 0.01; OR:0.23;95% CI:0.08-0.61).
UNASSIGNED: We found that a low SATT and BMI were related to a poor clinical outcome in our study group. It is essential to carefully examine these patients in detail, even in low-energy trauma. Subcutaneous tissue over the thorax serves as a protective shield for other thoracic structures in patients with LEBTT.

UNASSIGNED: Patients with anterior chest wall deformities unsuitable for minimally invasive repair are commonly treated by the modified Ravitch procedure. Although rigid plate fixation of the sternal osteotomy has previously shown to facilitate adequate sternal union, its use is troubled by an implant removal rate of up to 23% due to local complaints or complications associated with bulky plates. In contrast, the use of thinner and therefore biomechanically weaker plates may result in a higher incidence of non- or mal-union. In this pilot study, we evaluate the feasibility, efficacy and safety of rigid sternal fixation by thin pre-shaped anatomical locking plates during the modified Ravitch procedure.
UNASSIGNED: Between June 2018 and December 2019, all consecutive patients who underwent anterior chest wall deformity repair by the modified Ravitch procedure in our tertiary referral centre were included. Data was collected retrospectively. All pectus types were included. The sternal osteotomy was fixated using thin SternaLock Blu plates. Patients were followed for at least one year.
UNASSIGNED: Nine patients were included. The group consisted of six male and three female patients, with a median age of 20 years [interquartile range (IQR), 16-35 years]. Median duration of follow-up was 25 months (IQR, 16-28 months). No intraoperative complications occurred. No patients presented with symptomatic non- or mal-union. Plate removal was performed in one patient for atypical pain without relief. No other postoperative complications occurred.
UNASSIGNED: Based on these pilot results, thin SternaLock Blu plates are deemed to be safe and effective in providing adequate rigid fixation of the sternal osteotomy during the modified Ravitch procedure. Compared to literature, the need for plate removal within 25 months after surgery was reduced.

OBJECTIVE: Chest wall resections are most commonly performed for tumours, infection, radiation necrosis and trauma. Defects in the anterior chest greater than 5 cm, posterior defects more than 10 cm or resection including more than 3 ribs, independently of the location, require skeletal prosthetic reconstruction. The aim of this paper was to evaluate the strength of prostheses that reproduced the normal human anatomy using different materials subjected to the most dangerous loading conditions.
METHODS: The biomechanical behaviours of different prosthetic materials under critical rib fracture conditions were analysed using the finite element method and then validated through mechanical testing of 3-dimensional polymethylmethacrylate ribs as a prosthesis reproducing the native anatomy of the human ribcage.
RESULTS: The prosthetic materials and the polymethylmethacrylate prosthesis were tested under 3 load conditions: sternal load (an anterior-posterior load applied at the third rib); lateral load (strength applied at the lateral arch of the fifth rib) and vertical load (vertical load applied at the first sternocostal junction) and showed the same results in terms of failures compared to the results from the finite element method model simulation (same location and number of fractures were detected). Although the displacement error between the finite element method and experimental test was up to 5% overall, no other microcracking was observed.
CONCLUSIONS: This experimental study demonstrated that all prosthetic materials currently available for human use show optimal mechanical behaviour in term of resistance and organ protection. Specifically, polymethylmethacrylate was a good candidate as a prosthetic material in term of lightness, resistance and prosthetic weight.

OBJECTIVE: This study reports the incidence, severity, and predictors of musculoskeletal deformities (MD), including scoliosis and chest wall anomalies, following thoracic procedures in children.
METHODS: Children younger than 14 years who had thoracic surgery between 1997 and 2012 and had no other predispositions to MD, underwent longitudinal follow-ups with dedicated musculoskeletal examination performed in an esophageal atresia, orthopedic, or research clinic. Incidence of MD was calculated, and logistic regression methods were used to determine independent predictors, including sex, gestational age, age at procedure, serratus anterior muscle division, and chest tube placement.
RESULTS: The study cohort consisted of 104 patients followed for a median of 10.8 years (range 3-21). A total of 56 MD developed in 41 patients (39%), including scapular winging (24; 23%), scoliosis (17; 16%), and chest wall anomalies (15; 14%). The majority of MD were subclinical, with only 8 patients [8% (6 thoracotomies, 2 thoracoscopies)] requiring intervention. Among patients who underwent thoracotomies (93, 89%), serratus anterior muscle division was the only significant predictor of the development of MD [OR 8.9; 95% CI 2.8-32.6].
CONCLUSIONS: Musculoskeletal deformities develop in a significant proportion of children following thoracic surgery, but most are subclinical. A muscle-sparing technique decreases the incidence of these deformities.
METHODS: Prospective Cohort Study.
METHODS: Level II.

•Multicentre retrospective study involving breast and plastic units across the UK.•Will produce valuable data regarding management and outcomes.•Will inform decision making and help shape a future definitive study.