Principles of complex chest wall reconstruction

The complex chest wall reconstruction is a procedure required to repair large defects of the chest wall using a combination of materials including various flaps, omentoplasty, a microvascular technique and artificial replacements. The main indication for chest wall reconstruction is thoracic defects after resection of lung cancer, the repair of congenital deformities, post traumatic deformity and complications of surgery. It is commonly used for defects of more than 5 cm in diameter when four or more ribs are absent with the risk of lung herniation and paradoxical motion of the chest wall. The main technical principles of chest wall reconstruction are of a stable repair, compatibility of materials and meticulous surgical technique to minimise potential complications and the combination of available technologies. In lung cancer surgery chest wall reconstruction required after chest wall resection performed due to direct invasion of the tumour into the chest wall. The metal bars may be used to recreate the anatomically acceptable shape of the chest wall with or without artificial mesh. For large defects of the chest wall a combination of cement and natural flaps could be an ideal option. In young adults with pectus excavatum or pectus carinatum titanium bars allow to maintain stability after the open repair, but these bars require removal at a later stage, which is the down side of this procedure. The sternum may be alternatively secured with strips of Prolene Mesh positioned under the sternum and attached to the ribs in a tight fashion. Repair of late dehiscence of the sternum after median sternotomy requires firm stabilisation with metal bars, filling the defect with bone grafts and omentoplasty to improve blood supply of the affected sternum. Modern techniques of chest wall resection and reconstruction expand the surgical options of patients with chest wall defects and reconstruction should always be considered as part of the treatment plan for patients.