20240809 chest wall reconstruction.pptx20240809 chest wall reconstruction.pptx

20240809 chest wall reconstruction.pptx

1. Outline Principle Soft tissue defect Bony defect Diaphragm Algorithm

2. Primary muscles of respiration

3. Accessory muscles of respiration

4. Expiratory accessory muscles

5. Other chest wall muscles

6. Major risk factors C hest wall irradiation, Malnourishment, Obesity, Diabetes, Underlying pulmonary disease

7. Other risk factors S moking, Renal disease, Osteoporosis, Need for concomitant lung resection with anticipated prolonged ventilation

8. Soft tissue defect

9. 1 Vanstraelen, Stijn et al. “The contribution of microvascular free flaps and pedicled flaps to successful chest wall surgery.” The Journal of thoracic and cardiovascular surgery vol. 166,4 (2023): 1262-1272.e2. doi:10.1016/j.jtcvs.2023.05.018

10. Bony defect

11. Stabilisation Rib resection <2 ❌ >=2 - Posterior ❌ - Anterior/Lateral ✅ Sternal resection ✅

12. Synthetic mesh S arcoma, Resection of upper sternum, medial clavicle, and four upper ribs

13. Resection of f ive ribs spanning the lateral thoracic cage

14. Neo-rib Methyl methacrylate sandwich

15. Radiation? P ostmastectomy radiation therapy -> angiosarcoma. Resection of five anterior ribs DIEP only

16. Contamination? A nterior rectus sheath fascia

17. Sternal defect E arly and adequate débridement Retrosternal soft-tissue defect may occupied by the underlying mediastinum and lung Manubrium-clavicular ring Movement of nonunited bone segments against one another can cause significant pain

18. Diaphragm