CHEST WALL
RECONSTRUCTION
Zanella Y Lie, dr
Pembimbing :
dr. Dhihintia Jiwangga S W Sp.BTKV
SubspT (K)

Outline
⦿ History
⦿ Goals
⦿ Component for Reconstructive Approach
• Pleural cavity
• Skeletal Support
• Soft Tissue Coverage
⦿ Special Considerations
⦿ Conclusion

History
⦿ 1906 : First Muscle Flap (Tansimi)
⦿ 1950 : Pedicled Latissimus Dorsi muscle
flap (Campbell)
⦿ 1970s : Muscle and Myocutaneus Flap
(Mathes and Nahai)

Goals
(1) obliteration of dead space,
(2) restoration of skeletal
rigidity,
(3) prevention of lung herniation and scapula
impaction,
(4) protection of underlying organs, and
(5) maintenance of cosmesis

Pleural cavity
⦿ preserve airtight seal to generate negative
pressure for respiration
⦿ Obliterate postpneumonectomy dead
space
⦿ Vascularized tissue is considered
essential for this process
⦿ If empyema exists, the antibiotic coverage
should be started as soon as possible
before reconstruction
⦿ Thoracoplasty is the last resort

Skeleton (Rigid Parts)

Quality of Ideal Prosthesis
(1) rigidity to protect underlying organs and
prevent paradoxical movement,
(2) inertness to allow in-growth of fibrous
tissues and decrease infection,
(3) malleability such that it can be conformed to
the desired shape,
(4) radiolucency to provide reference during
follow-up.

Materials of Skeletal Framework
(Mesh and Patch)
Synthetic
- Easy Handling
- Long Lasting tolerability
- In-growth of regenerative tissues
- permeability prevents occurrence of
seroma
- Prone to Infection
Biologic
⦿ Resistant to Infection
⦿ Laxity and Loss of chest all stability

PTFE
Marlex
Merilene

Materials of Skeletal Framework
(Methyl Methacrylate)
“Marlex Sandwich”
⦿ rigidity
⦿ customization of shape to
reconstruct different
contours and sizes
⦿ Hinder physiologic
movement
⦿ Seroma formation

Materials of Skeletal Framework
(Titanium Plates)
⦿ Highest strength
⦿ resistent to infection
⦿ more physiologic rib
movement
⦿ Combined with mesh for
visceral coverage

Soft Tissue
1. Local Muscle Flaps
a. Latissimus Dorsi
b. Pectoralis Major
c. Rectus Abdominis
d. Serratus Anterior
2. Omental Flaps
3. Free Tissue Transfer

Technique
⦿ Graft put in the defect
⦿ suture using non absorbable monofilamen
suture in interuptted pattern
⦿ Coverage is usually accomplished by
muscle flaps

Special Consideration
Infected Field
5-233% Incidence of infection after
reconstruction
If infectied field must be reconstructed, use
titanium and acellular collagen, vacuum
assisted closure

Conclusion
Every Material has its advantages and
disadvantages
Reconstruction’s goals is preserving
physiologic movement of chest wall to
maintain respiration

THANKYOU