Chest-wall reconstruction: an account of 500 consecutive patients

Our experience with 500 consecutive chest-wall reconstructions over the past 18 years is reviewed. Of the 500 patients, 286 were male and 214 were female. Their ages ranged from 1 day to 85 years (average 55 years). Among the patients, 275 had chest-wall tumors, 142 had infected median sternotomies, 119 had radiation necrosis, and 121 had combinations of the three. Skeletal resection of the chest wall was done in 443 patients. An average of 3.9 ribs were resected in 241 patients. Total or partial sternectomies were performed in 231 patients. Four-hundred and seven patients underwent 611 muscle flaps: 355 pectoralis major, 141 latissimus dorsi, and 115 others, including serratus anterior, rectus abdominis, and external oblique. The omentum was transposed in 51 patients. Chest-wall skeletal defects were closed with polytetrafluoroethylene soft-tissue patch in 116 patients, polypropylene mesh in 55, and autogenous rib in 13. The 500 patients underwent an average of 2.3 operations. Hospitalization averaged 21 days. There were 15 perioperative deaths. Twenty-three patients required tracheostomy. The average duration of follow-up was 57 months. There were 229 late deaths; the cause of death was cancer in 147 patients, cardiac in 49, pulmonary in 7, and other in 26. Four-hundred and three of the 485 patients (83.1 percent) who were alive 30 days after the operation had excellent results and had a healed, asymptomatic chest wall at the time of death or last follow-up. We conclude that chest-wall reconstruction is safe, durable, and associated with long-term survival.