Longevity of Double-Layered Polypropylene Mesh with Methylmethacrylate in Chest Wall Reconstruction: A Case Report

Abstract

Chest wall tumors, particularly neurofibromas—benign yet locally aggressive peripheral nerve sheath tumors—challenge thoracic surgeons due to their proximity to vital structures, recurrence risk, and demands for radical resection and stable reconstruction. This report describes a 62-year-old woman with recurrent right chest wall neurofibroma involving ribs 3–9, treated 10 years ago via wide excision and "sandwich technique" reconstruction using double-layered polypropylene mesh (ETHICON™ PROLENE®) reinforced with polymethylmethacrylate (PMMA). In a resource-limited setting without titanium prostheses, the 20 × 15 cm defect was addressed by molding PMMA between mesh layers, securing it to adjacent ribs with wires, and covering with a latissimus dorsi flap for rigidity, biocompatibility, and infection resistance. Postoperative recovery was uneventful, with discharge on day 7. Over 10 years, annual CT surveillance showed sustained prosthetic integrity—minor superficial mesh breaches (<1 cm) but no fragmentation or migration—and initial suspected recurrence (2 × 1.5 cm mass at year 9) that regressed spontaneously (1.5 × 1 cm at year 10), with no invasion or complications. The patient reported mild pain (VAS 2/10) but preserved pulmonary function and ambulation. This case highlights the polypropylene–PMMA composite's decade-long durability and cost-effectiveness ($50–100 vs. $500+ for titanium) as an alternative for large defects in low-resource environments. It supports wider use of hybrid techniques with vigilant follow-up for oncologic and prosthetic monitoring, advancing equitable thoracic surgery.