Lower third chest wall reconstruction in a bilateral sequential lung transplant recipient

Area of Science:

• Thoracic surgery
• Reconstructive surgery
• Transplant surgery

Background:

• Deep sternal wound infection (DSWI) poses significant morbidity and mortality risks in cardiothoracic patients.
• Reconstructing the sternum, particularly the lower third, presents unique challenges in transplant recipients due to immunosuppression, comorbidities, and prior surgeries.
• Standard reconstructive techniques may be limited in these complex cases.

Observation:

• A bilateral lung transplant recipient developed a DSWI requiring chest wall reconstruction.
• The patient's condition necessitated a reconstructive approach that minimized operative time and utilized available tissues.
• The lower third of the sternum was the primary site of the defect.

Findings:

• Successful lower third chest wall reconstruction was achieved using a combination of bilateral pectoralis advancement flaps and omentoplasty.
• This combined approach provided adequate coverage and facilitated wound healing in an immunocompromised patient.
• The surgical strategy was tailored to the patient's specific challenges, including immunosuppression and limited donor options.

Implications:

• This case demonstrates a viable reconstructive strategy for complex sternal defects in challenging patient populations.
• The combined pectoralis advancement flap and omentoplasty technique offers a potential solution for lower chest wall reconstruction in transplant recipients.
• Further research could explore the long-term outcomes and broader applicability of this reconstructive method.