Narrative review: a multidisciplinary approach to chest wall reconstruction

Chest wall reconstruction (CWR) remains a surgical challenge for both thoracic and plastic surgeons owing to the physiologic and anatomic complexity of the region. Successful reconstruction re-establish chest wall integrity, obliterate dead space, preserve pulmonary function, and ensure robust soft tissue coverage. This narrative review discusses modern principles of CWR, including advances in biomaterials and surgical techniques, with an emphasis on the role of thoracoplastic collaboration.

A literature search was performed on PubMed for MeSH terms and keywords pertinent to CWR. Randomized controlled trials, retrospective studies, systematic reviews and case studies published from November 5, 1995 through November 5, 2025 were eligible for inclusion.

New biomaterials have popularized hybrid and mesh-based approaches to skeletal fixation that preserve respiratory function and protect native tissue from implanted materials. Virtual surgical planning (VSP) and three-dimensional (3D) technology is increasingly used for operative planning and fabricating custom prostheses. While local pedicled flaps remain a mainstay of soft tissue reconstruction, advances in microsurgical tissue transfer have allowed for reconstruction of increasingly large and complex defects. Employing a thoracoplastic approach to CWR is vital to successfully reconstructing complex defects.

CWR remains an area of active innovation, and reconstructive approach varies widely by anatomic region, defect characteristics, and surgeon preference. The rise of new biomaterials and 3D printing holds immense promise for custom reconstructive approaches. Formalized thoracoplastic collaboration throughout the perioperative period is crucial to leveraging the expertise of both thoracic and plastic surgeons, particularly in highly complex cases.