What is chest wall reconstruction?

Chest wall reconstruction is usually performed when there is an infections after open heart surgeries or chest wall defects after resection of tumors. Reconstruction of the chest wall is also performed for patients who have conditions such as congenital deformities, cancer, or problems with non-healing wounds.

The reconstruction procedure involves involves reconstruction of the ribs, sternum, costal cartilages, and the accompanying soft tissue. As both bony and soft tissue elements are required for the chest wall reconstruction, which makes it challenging for plastic and reconstructive surgeons.

For reconstruction, either regional flaps or mesh is used. Flaps consists of skin/subcutaneous fat, or skin/subcutaneous fat/muscle for covering the severely damaged tissue. Artificial meshes made up of alloplatic or biologic material are used during the surgery to cover the chest wall defect or to provide stability to the defect or to provide platform for the flap.

What are the types of surgeries in chest wall reconstructions?

Closure of Postpneumonectomy Empyema Cavities

Identification of bronchopleural fistula and their closure with muscle flaps like – latissimus dorsi flap, Serratus anterior, pectoralis major, omentum and lastly rectus abdominis.

Treatment of Infected Sternums

Muscle flaps used for sternal defects are the pectoralis turnover flap, rotation-advancement pectoralis flap, segmental pectoralis flap, RAM flap, EOM flap, LDM flap, and the omentum.

Soft Tissue Reconstruction of the Chest Wall

Partial-thickness defects most commonly are treated with skin grafting, preferably split-thickness grafting for larger surface areas.

Full-thickness defects require muscle flaps are chosen based on the skin requirements of the defect, stability of the thoracic wall, the need to protect the thoracic viscera, and donor site considerations. The most common muscle flaps used are the LDM (latissimus dorsi muscle flap), PMM(pectoralis Major Muscle), and RAM.(Rectus abdominis muscle).

Which individuals are suitable for the surgery?

Individuals who are suffering from following conditions are suitable for the surgery.

• Tumor radiation injury
• Trauma to chest wall
• Infections to the chest wall and thoracic cavity such as empyema, pneumonia, and bronchopleural fistula
• Abnormalities of sternum, rib cage, and shoulders
• Chest wall deformities such as pigeon breast (pectus carinatum) and funnel chest (pectus excavatum)
• Surgical resection of chest wall, pulmonary or mediastinal tumors
• Congenital defect of the chest wall like Poland syndrome (underdeveloped or absence of muscles of the chest wall), pectus excavatum and pectus carinatum.

How should I prepare for the surgery?

Before the surgery, you need to

• Undergo physical examination and several diagnostic tests
• Quit smoking and alcohol as it may interfere with recovery
• Stop taking blood thinners and medications that contain aspirin as they may cause bleeding
• Do not eat anything after the midnight
• Use daily medications just with a sip of water
• Shower in the morning on the day of surgery and wash the surgical site with chlorhexidine scrub

What is the aftercare of the surgery?

After the surgery, you may be required to stay for 4 to 5 days in the hospital. However, it depends on your physical condition. You will be given pain medicines to relieve from postoperative pain. You should not drive until you have stopped pain medications. You have to follow certain instructions suggested by your surgeon for a quick recovery.

• Avoid strenuous exercise
• Practice deep breathing using your diaphragm
• Avoid heat application to the surgical site
• Stop the medications that cause allergic reactions
• Sleep in a position that is comfortable
• Avoid lifting objects heavier than 10 pounds

What are the complications after chest wall reconstructive surgery?

The common risks and complications after chest wall reconstruction surgery are:

• Infection
• Flap necrosis
• Skin paddle epidermolysis
• Loss of sensation
• Scars
• Hematoma and seroma