Chest wall reconstruction: success of a team approach—a 12-year experience from a tertiary care institution

Abstract

Background The thoracic cavity was considered as a forbidden area in the past and anyone attempting to meddle with it was expected to be doomed. But the past several decades have seen a marked improvement in the management and reconstruction of complex chest wall defects. This study was undertaken to review our experience in chest wall reconstruction during the past 12 years and to stress upon the importance of a multidisciplinary team approach to this complex problem. Methods After obtaining the necessary clearance from institutional ethics committee, we did a retrospective review of all case records of chest wall reconstructions (CWR) performed in our institution during a 12-year period from May 2005 to September 2016. Patient characteristics, co-morbidities, operative data and post-operative complications and outcomes were reviewed.Results During the study period, a total of 32 patients underwent CWR. All patients were assessed, planned, operated and managed by a team consisting of thoracic surgeons, plastic surgeons, intensivists and pulmonologists. Patients were in the age group of 14-72 with a male:female ratio of 15:17. Indications for CWR were neoplasms (n = 13-40.62%), post-sternotomy wound dehiscence (n = 12-37.5%), osteoradionecrosis (n = 4-12.5%), tuberculosis (n = 2-6.25%) and osteomyelitis rib (1/32-3.125%). Inflammatory defects were mostly closed with soft tissue alone whereas skeletal stabilisation with soft tissue cover was required in tumour resections. All were pedicled flaps, the most common being pectoralis major (PM) muscle flap (n = 12). Others include latissimus dorsi (LD) muscle (n = 9); rectus abdominis (RA) muscle (n = 2); transverse rectus abdominis musculocutaneous flap (TRAM) (n = 2), deltopectoral (DP) (n = 1), omentum (n = 3) and breast flap (n = 3). Post-operative complications include wound dehiscence (12%), wound infection (21%) and recurrent sinus formation (7%). One partial flap failure was recorded. Post-operative mortality was 3%. Conclusion Chest wall reconstruction is a complex procedure and each defect needs an individualised approach for optimum outcome. Extensive chest wall resections can be safely undertaken with the support of the reconstructive surgeon and with good critical care back up.

The sternum reconstruction: Present and future perspectives

“…Although satisfactory results in high-grade tumors have not been reported, in patients with limited local recurrence or one metastasis, resection may be possible with good long-term survival ( 5 , 44 – 47 ). Nevertheless, in large sternal defects or patients with an irradiated sternum, reconstruction using musculocutaneous flaps is preferred because of the reduced risk of infection ( 24 , 40 , 46 ). Additionally, the use of methyl methacrylate mesh is recommended for reconstruction after complete sternectomy ( 48 ).…”

Hybrid nanocomposite as a chest wall graft with improved vascularization by copper oxide nanoparticles

“…Current therapeutic options include biological as well as synthetic materials. Whenever repair of the chest wall is impossible by autologous tissue such as musculotaneous, 1 muscular pedicled flaps 2,3 or omental flaps, 3 allogeneic materials are required for sufficient coverage of the defect. Of these, new natural or synthetic biomaterials offer a great opportunity in the field of thoracic reconstruction.…”

Vertical Rectus Abdominis Muscle Flap for Repair of the Anterior Chest Wall Defect

“…вопрос о реконструктивно-восстановительной операции на передней грудной стенке неизбежно возникает перед хирургом при лечении опухолей грудной стенки, рака молочной железы, последствий травм груди, а также при лечении последствий гнойных заболеваний, в частности постлучевого остеомиелита грудины и постстернотомного медиастинита. Локализация дефекта позволяет использовать аутологичный пластический материал из различный анатомических областей -шеи, груди, брюшной стенки и спины, а также брюшной полости [1,2,3,4,5,6]. В литературе приводятся противоречивые аргументы в пользу того или иного способа устранения дефекта грудной стенки при постстернотомном медиастините [7,8].…”