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Dr. Chiara Oreglio - Best of the Best in Pediatric Surgery 2025
With Dr. Chiara Oreglio & Dr. Laura Galganski
Educational content from recorded physician discussions — not medical advice. Talk to your (or your child's) care team about your situation.
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What the experts said
Primary chest wall tumors are a rare entity in pediatric population with Ewing sarcoma being the most common one.
Surgery remains the mainstay of treatment for primary chest wall tumors, composed of a demolitive phase and a reconstructive phase.
The material of choice for chest wall reconstruction must encompass features of both stiffness and malleability while being biologically compatible.
The reconstructive material must be able to physiologically integrate with tissues and cope with the ongoing growing process in pediatric patients.
The series includes the youngest patient affected by chest wall Ewing sarcoma reported in literature, an 18-month-old female.
The institution used porcine acellular dermal collagen (Permacol) for chest wall reconstruction.
Three patients were treated: two males and one female (18 months old at diagnosis).
The surgical technique aims for 'drum-like tension'—tension strong enough to guarantee internal organ protection while accommodating chest wall growth.
A latissimus dorsi muscular flap is created, rotated, and fixated over the prosthesis with sparing of the thoracodorsal artery.
In all patients, at least three ribs were removed in accordance with oncological guidelines.
In two cases, there was diaphragmatic involvement that was removed and reconstructed with Permacol.
In one case with a large defect, two Stratos bars (rigid material) were used in addition to Permacol, instead of the usual four bars.
None of the patients reported any perioperative complications according to the Clavien classification.
R0 resection was reached in all cases.
All patients were able to restart chemotherapy within two months from surgery.
No limitations of movement are reported by any of the patients.
The youngest case shows no paradoxical chest wall movement at follow-up and is disease-free.
Permacol mesh presents good adaptability to the growing process with a reduced risk of rejection and infection.
Permacol is highly versatile for reconstruction of highly mobile tissues such as the diaphragm.
The thickness of the Permacol mesh can be adjusted according to age, region to be reconstructed, and defect size, making it feasible even in very young children.
Permacol can be associated with other synthetic materials in hybrid reconstruction.
Compared to rigid structures like titanium bars or Stratos bars, bioprosthesis integrates with tissue and grows with surrounding tissue as the patient grows.
Rigid bars like Stratos bars oblige surrounding ribs to remain fixed, modifying chest wall shape and leading to scoliosis or chest wall deformation as the most common complication.
With bioprosthesis, tissues are free to grow in their own way without chest wall deformity.
The oldest patient treated with Permacol did not develop any difficulty in movement, and imaging shows the rib cage is not deformed.
The histological integration of the bioprosthesis with surrounding tissue does not prevent growth or movement of the tissue.