Chest Wall Reconstruction after Surgical Resection: An Approach towards Various Techniques and Materials

Abstract

Extensive chest wall resection and reconstruction is a challenging procedure that requires a multidisciplinary approach, including input from thoracic surgeons, plastic surgeons and oncologists. Neoplastic chest wall pathologies are associated with a high surgical morbidity and can result in full thickness defects which are complicated to reconstruct. The goals of a successful chest wall reconstruction is to restore the chest wall rigidity, preserve ventilatory mechanics and protect the intrathoracic organs. Large full thickness defects require reconstruction with synthetic, biologic or composite meshes with or without titanium plate to restore thoracic cage rigidity. After skeletal stability is established full tissue coverage can be achieved using direct sutures, skin grafts or local advancement flaps, pedicled myocutaneous flaps or free flaps. The aim of this chapter is to illustrate the indications and the various materials and techniques for chest wall reconstruction with the goal of obtaining the best chest wall rigidity and soft tissue coverage.