Key Points

• The anatomy of chest wall and sternum is important from a surgical standpoint.
• Knowledge of the thoracic inlet and outlet of thorax, knowledge and understanding of the importance of the extrathoracic muscles of the chest wall, and knowledge of chest wall mechanics are prerequisites in the training of the cardiothoracic surgeon.
• Various muscle flaps may be used to provide coverage, wrapping, and filling of defects.

The anatomy and physiology of the chest wall and sternum are completely intertwined.[1] The musculoskeletal structure of the chest wall and sternum serve to protect the lungs and thoracic viscera. Surgeons must have a thorough knowledge of the external bony landmarks, the muscles of the chest wall, and their intertwined workings to appreciate the physiology of respiration and anatomic movement.