Interdisciplinary thoraco-plastic surgery for chest wall reconstruction: a clinical practice review based on single-center quality control data

Thoracic defects arise from a broad spectrum of causes, including tumours, congenital deformities, infections, and radiation-induced damage. Their surgical management is often challenging and typically requires close interdisciplinary cooperation, particularly between thoracic and plastic surgeons. This retrospective project included all patients who underwent thoracic wall resection and subsequent reconstruction at the University Hospital Basel between January 2013 and January 2025. During this 12-year period, 89 patients with chest, lung, pleura, and breast pathologies underwent thoracic reconstruction. The proportion of patients with an oncological diagnosis was 17% (n=15). Overall, there were 63 men (71%) and 26 women (29%). The mean age was 64±13 years. Pectoralis major flaps were used in 34 patients; latissimus dorsi (LD) flaps were used in 25 patients, with additional pectoralis major flaps in 2 patients and a combination of pectoralis flap reconstruction with a vertical rectus abdominis myocutaneous (VRAM) flap in 3 patients. Isolated VRAM reconstruction was performed in 4 patients, and in one patient, transverse rectus abdominis myocutaneous (TRAM) flap reconstruction was performed. In 2 patients, the serratus anterior muscle was used, and in one patient each, a vastus lateralis flap and an obliquus externus flap were applied for defect coverage. In 16 patients, the defect was covered plastically by local skin rotation. Chest wall reconstruction following extensive thoracic resection is safe and effective when guided by a structured, stepwise approach and close interdisciplinary collaboration.