PMC6476009_01
Chest radiography before and after the first operation. (a) Before the operation; arrow: the chest wall tumour. (b) At discharge.
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A 68-year-old female underwent a partial left-sided chest wall resection, with partial removal of the 6th and 7th ribs and of the scapula angle for elastofibroma (Figure 1(a)). The postoperative course was uneventful; the radiographic aspect at discharge was normal (Figure 1(b)).
Computerised tomography of the chest at the time of hernia diagnosis. (a) Axial view. (b) Coronal view.
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The first symptoms in the form of pains in the region of the incision appeared five months after the operation, and computer tomography (CT) of the thorax showed a lung hernia in the region of the mesh covering the chest wall defect (Figures 2(a) and 2(b)).
Computerised tomography of the chest at the time of hernia repair.
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The repeated chest CT showed a slight increase in hernia size, with no signs of tumour recurrence (Figure 3), so that reoperation was planned.
Operative view after hernia exposure. Arrows: mesh disruption region; 1: mesh; 2: lung hernia.
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After the excision of the previous skin scar and the incision of the muscular layer, the mesh region was exposed, showing a lung protrusion (4 x 3 cm) along the anterolateral edge of the mesh (Figure 4).
Schema of the local situation at the first and redo surgeries. (a) First surgery: mesh in place over the chest wall defect; scapula angle removed. (b) Redo surgery for hernia repair: lung protrusion along the disrupted anterolateral part of the mesh.
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The local situation is schematically presented on Figure 5.
Separation of the mesh from the lung. 1: lung; 2: mesh.
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By careful dissection, the mesh was separated from a firmly adherent lung and removed (Figure 6).
One Synthes plate fixated over the Mersilene mesh covering the chest wall defect.
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After the chest tube insertion, the chest wall defect was reconstructed by suturing a Mersilene mesh in two layers:single pericostal sutures for initial fixation and running suture for additional reinforcement (Figure 7). A final chest wall stabilization was done by the fixation of two Synthes plates (DePuy Synthes J&J) over the 5th and 6th ribs (Figure 7).
Chest radiography at discharge.
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The chest X-ray on discharge, on postoperative day 5, is presented in Figure 8.