Management of Chest Wall Defects with Soft Tissue and Bony Defect, a Clinical Experience

Çeçen S., Biner M. M., Alkan A. Ö., Özgenel G. Y.

12 BAPRAS CONGRESS 2023, Konya, Türkiye, 13 - 16 Eylül 2023, ss.51-54

  • Yayın Türü: Bildiri / Tam Metin Bildiri
  • Basıldığı Şehir: Konya
  • Basıldığı Ülke: Türkiye
  • Sayfa Sayıları: ss.51-54
  • Bursa Uludağ Üniversitesi Adresli: Evet

Özet

Introduction

The chest wall comprises vital organs and vasculature. It covers and shields these structures with the sternum, ribs, attached muscles, and overlying fascia and skin. In addition to this, the sternum, ribs, and muscles help inspiration as accessory elements.

Skin grafts or local skin flaps are primary but good options for chest wall defects without full-thickness involvement. Regional muscle flaps, such as pectoralis major, latissimus dorsi, rectus abdominis, external oblique, serratus anterior, or omental flaps, are essential options in case of significant soft tissue defects, dead space obliteration, or coverage for prosthetic material.

This study aimed to examine the patients who needed reconstruction due to full-thickness defect in the chest wall and their results.

Material and Methods

Between February 2019- February 2023, 24 patients had operations due to chest wall defects for various reasons. Nine patients out of 24 patients had both soft tissue and bony defect situated on the anterior and lateral sides of the chest wall. Eight patients’ defects were due to the tumor ablation, and one was secondary to the bypass surgery.

Results

No total loss was observed in other flaps except the loss of one free flap that was due to cardiopulmonary arrest. In two patients who underwent latissimus dorsi flap, the skin graft performed in the first session had lysis due to infection and was re-grafted with adequate granulation after the follow-up.

Discussion and Conclusion

Reconstruction needs may arise in the thoracic wall for various reasons, including tumor excision, trauma, and radiotherapy. These factors can result in defects of varying depth and width. Therefore, when a reconstruction need is identified in the thoracic wall, a careful analysis should be conducted to assess the losses incurred as a result of previous surgeries or radiotherapy and to determine the remaining viable structures.

The extent of the planned surgery, the depth of the defect, and the exposure of essential structures all play individual roles decision-making process. The integrity of nearby regional options and vascular pedicles should be individually assessed. Taking into consideration the conditions mentioned earlier, reconstruction options should be evaluated.