Feedback

Chest Wall and Sternum Resection and Reconstruction

Karl Fabian L. Uy, Alexander Pong, John Castle, Cameron T. Stock Jr, Geoffrey M. Graeber

Key Points

  • Surgical resection of the chest wall should be undertaken with the fullest possible understanding of the pathology involved as well as the physiology of the patient.
  • Chest wall stabilization will be required in the minority of patients but a plan should be in place since intraoperative findings dictate the final extent of resection.
  • Available expertise and materials impacts on selection of reconstruction technique if this is needed.
  • Pedicled flap reconstruction is the current mainstay of soft tissue coverage.
  • Occasionally, more than one flap will be necessary to cover large defects.
  • The availability of synthetic and biologic reconstructive materials is ever-changing because of the fast pace of technological innovation.

Chest wall resection is usually performed for one of five reasons:

  1. Removal of neoplasms
  2. Eradication of entrenched infection
  3. Excision of radiation injuries
  4. Débridement of traumatic wounds
  5. Correction of congenital defects

These indications for chest wall resection are not mutually exclusive because infection can be a major complication for each of the others. Recurrent tumor and infection together can complicate radiation injuries. Although there are brief discussions about issues pertinent to chest wall neoplasms among others, this chapter focuses more on technical surgery and a more detailed discussion of neoplasms and other pathologies are available in other chapters. Before any major resection, the surgeon should make a thorough and accurate assessment of the patient to avoid major complications.[1],[2] In the trauma patient the resection may have to proceed even in victims who are poor operative risks because allowing devitalized material to remain invites catastrophic infection.[3]

There's more to see -- the rest of this topic is available only to subscribers.

Last updated: March 10, 2026