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  1. CHEST WALL RECONSTRUCTION Zanella Y Lie, dr Pembimbing : dr. Dhihintia Jiwangga S W Sp.BTKV SubspT (K)
  2. Outline ⦿ History ⦿ Goals ⦿ Component for Reconstructive Approach • Pleural cavity • Skeletal Support • Soft Tissue Coverage ⦿ Special Considerations ⦿ Conclusion
  3. History ⦿ 1906 : First Muscle Flap (Tansimi) ⦿ 1950 : Pedicled Latissimus Dorsi muscle flap (Campbell) ⦿ 1970s : Muscle and Myocutaneus Flap (Mathes and Nahai)
  4. 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
  5. 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
  6. Skeleton (Rigid Parts)
  7. 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.
  8. 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
  9. PTFE Marlex Merilene
  10. Materials of Skeletal Framework (Methyl Methacrylate) “Marlex Sandwich” ⦿ rigidity ⦿ customization of shape to reconstruct different contours and sizes ⦿ Hinder physiologic movement ⦿ Seroma formation
  11. Materials of Skeletal Framework (Titanium Plates) ⦿ Highest strength ⦿ resistent to infection ⦿ more physiologic rib movement ⦿ Combined with mesh for visceral coverage
  12. 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
  13. Technique ⦿ Graft put in the defect ⦿ suture using non absorbable monofilamen suture in interuptted pattern ⦿ Coverage is usually accomplished by muscle flaps
  14. 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
  15. Conclusion Every Material has its advantages and disadvantages Reconstruction’s goals is preserving physiologic movement of chest wall to maintain respiration