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Semin Plast Surg 2011; 25(1): 086-097
DOI: 10.1055/s-0031-1275175
© Thieme Medical Publishers

Complications, Pitfalls, and Outcomes After Chest Wall Reconstruction

David T. Netscher1 , Shayan Izaddoost1 , Brinkley Sandvall1
  • 1Department of Orthopedic Surgery, Division of Plastic Surgery, Baylor College of Medicine, Houston, Texas
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Publication History

Publication Date:
05 April 2011 (online)

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ABSTRACT

Chest wall and mediastinal wounds may be life-threatening. Although modern reconstruction methods with various muscle flaps have reduced morbidity and mortality, chest wall reconstruction presents unique challenges. Major categories of adverse outcomes include (1) persistent infection; (2) interference with respiratory mechanics; (3) functional deficits of the shoulder; and (4) hernias. Persistent infection may be resolved by providing coverage via muscle or omental flap, performing thorough debridement, filling the “dead space” with adequate volume, buttressing repair of visceral fistulae, and covering exposed prosthetic material with vascularized flaps. Potential deficits in respiratory mechanics and shoulder function may be avoided by stabilizing the chest wall skeleton and decreasing donor muscle functional loss. Hernias may be minimized by maintaining visceral “right of domain” to the chest and abdominal cavities. Complex reconstructive cases represent an intricate interplay of physiology, structural protection, and aesthetic considerations and require integration of several management principles.

KEYWORDS

Chest wall - mediastinum - reconstruction

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David T NetscherM.D. 

Clinical Professor, Division of Plastic Surgery, and Professor, Department of Orthopedic Surgery, Baylor College of Medicine

Houston, TX 77030

Email: netscher@bcm.tmc.edu

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