Safety and Feasibility of Prolene Mesh Alone for Reconstruction After Moderate Chest Wall Resection: A Retrospective Observational Study.

Abstract

Background: Moderate defects of the chest wall resulting from surgery for cancer require reconstruction in order to reestablish stability of the thorax. A flexible alternative to rigid prosthetics can be offered by polypropylene mesh; however, there are limited standardized outcome data available. Methods: The study was retrospective in nature and included 23 consecutive patients who underwent reconstruction with Prolene mesh due to moderate defects (greater than 5 cm or greater than 3 ribs) at four tertiary care centers between 2023 and 2025. The main outcomes measured were postoperative complications and pulmonary failure. The secondary outcomes measured were the length of drain placement and the length of hospital stay. Results: The cohort consisted of 23 individuals with a mean age of 41.4 (±20.5) years and a median defect size of 12 cm × 10 cm. No patient developed paradoxical motion, pulmonary failure, or infection related to the mesh. The overall morbidity rate was 39.1% (9/23), and all complications reported were classified as Clavien-Dindo grade I or II and included superficial wound infection (17.4%), atelectasis (17.4%), and seromas (13.0%). The median duration of ICU stay was 1 day (IQR: 1-1), the median duration of chest tube placement was 3 days (IQR: 2-3), and the median duration of hospital stay was 7 days (IQR: 7-8). Spearman's rank correlation analysis demonstrated a significant positive correlation between defect surface area and total hospital stay (rho = 0.67, p = 0.001). Patients with comorbidities had significantly longer hospital stays (median 9 vs. 7 days; p = 0.012) and Redivac drain durations (median 6 vs. 5 days; p = 0.016) compared to those without comorbidities. Conclusion: Prolene mesh alone is safe and technically feasible for moderate chest wall reconstruction, with no mechanical failures, low minor morbidity, and rapid postoperative recovery. Its use can be confidently considered as a first-line approach when appropriate mesh tensioning and viable soft tissue coverage are achieved, offering reassurance in surgical decision-making.