[Reconstruction of full-thickness chest wall defects]

To investigate the surgical techniques and effectiveness for reconstruction of severe full-thickness chest wall defects.

Between January 2006 and December 2010, 14 patients with full-thickness chest wall defects were treated, including 12 cases caused by giant chest wall malignant tumor excision, 1 case by thermocompression injury, and 1 case by radiation necrosis. There were 8 males and 6 females with an average age of 42 years (range, 23-65 years). The size of chest wall defects ranged from 8 cm x 5 cm to 26 cm x 14 cm. All patients complicated by rib defect (1-5 ribs), and 3 cases by sternum defect. Thoracic skeleton reconstruction was performed with Vicryl mesh or polytetrafluoroethylene mesh in 10 patients. Other 4 patients did not undergo thoracic skeleton reconstruction. The bilobed skin flaps, pectoralis major myocutaneous flap, latissimus dorsi myocutaneous flap, and rectus abdominis myocutaneous flap were utilized for repairing soft tissue defects. The size of the dissected flaps ranged from 10 cm x 7 cm to 25 cm x 13 cm. The donor sites were sutured directly or were repaired by free skin graft.

Poor healing of incision occurred in 2 cases, which was cured after debridement, myocutaneous flap transfer, and skin graft. The other wounds healed by first intention. All patients were followed up 6-36 months (mean, 8 months). No tumor recurrence during follow-up, except 1 patient with osteosarcoma who died of liver metastasis at 6 months after operation. Transient slight paradoxical respiration occurred in 1 patient who did not undergo thoracic skeleton reconstruction at 5 days after operation. Integrity of chest wall in other patients was restored without paradoxical respiration and dyspnea.

Depending on the cause, the size, and the location of defect, single or combination flaps could be used to repair soft tissue defect, and thoracic skeleton reconstruction should be performed when defect is severe by means of synthetic materials.