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Chest Wall and Sternum Resection and Reconstruction

Karl Fabian L. Uy, Cameron T. Stock Jr, Geoffrey M. Graeber
Chest Wall and Sternum Resection and Reconstruction is a topic covered in the Pearson's General Thoracic.

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Key Points

  • Surgical resection of disease processes of the chest wall should be undertaken with a full understanding of the pathology afflicting the patient.
  • Thorough evaluation of the entire patient should take place before the resection.
  • Chest wall stabilization will be required in only a few selected instances after the chest wall pathology has been removed.
  • Pedicle flap reconstruction will offer the key to soft tissue coverage of any defect in the chest wall.
  • Occasionally, more than one flap will be necessary to cover large defects. With careful attention to detail, the morbidity and the mortality from resection of chest wall pathology and reconstruction should be low.
  • The outcome in most patients should be satisfactory and will depend on the type of disease process that has been resected from the chest wall.

Chest wall resection is usually performed for one of five reasons:

  1. Removal of neoplasms
  2. Eradication of entrenched infection
  3. Excision of radiation injuries
  4. Débridement of traumatic wounds
  5. Correction of congenital defects

These indications for chest wall resection are not mutually exclusive because infection can be a major complication for each of the others. Recurrent tumor and infection together can complicate radiation injuries. The following discussion delineates the essential surgical principles governing chest wall resection for each of the five major indications. Before any major resection, the surgeon should make a thorough and accurate assessment of the patient to avoid major complications.[1],[2] In the trauma patient the resection may have to proceed even in victims who are poor operative risks because allowing devitalized material to remain invites catastrophic infection.[3]

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Key Points

  • Surgical resection of disease processes of the chest wall should be undertaken with a full understanding of the pathology afflicting the patient.
  • Thorough evaluation of the entire patient should take place before the resection.
  • Chest wall stabilization will be required in only a few selected instances after the chest wall pathology has been removed.
  • Pedicle flap reconstruction will offer the key to soft tissue coverage of any defect in the chest wall.
  • Occasionally, more than one flap will be necessary to cover large defects. With careful attention to detail, the morbidity and the mortality from resection of chest wall pathology and reconstruction should be low.
  • The outcome in most patients should be satisfactory and will depend on the type of disease process that has been resected from the chest wall.

Chest wall resection is usually performed for one of five reasons:

  1. Removal of neoplasms
  2. Eradication of entrenched infection
  3. Excision of radiation injuries
  4. Débridement of traumatic wounds
  5. Correction of congenital defects

These indications for chest wall resection are not mutually exclusive because infection can be a major complication for each of the others. Recurrent tumor and infection together can complicate radiation injuries. The following discussion delineates the essential surgical principles governing chest wall resection for each of the five major indications. Before any major resection, the surgeon should make a thorough and accurate assessment of the patient to avoid major complications.[1],[2] In the trauma patient the resection may have to proceed even in victims who are poor operative risks because allowing devitalized material to remain invites catastrophic infection.[3]

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Last updated: March 22, 2020