Chest wall reconstruction restores respiratory function, provides protection for underlying viscera, and supports the shoulder girdle. Common indications for chest wall reconstruction include neoplasms, trauma, infectious processes, and congenital defects. Loss of chest wall integrity can result in respiratory and cardiac compromise and upper extremity instability. Advances in reconstructive techniques have expanded the resectability of large complex oncologic tumors by safely and reliably restoring chest wall integrity in an immediate fashion with minimal or no secondary deficits. The purpose of this article is to provide the reader with current evidenced-based knowledge to optimize care of patients requiring chest wall reconstruction. This article discusses the evaluation and management of oncologic chest wall defects, reviews controversial considerations in chest wall reconstruction, and provides an algorithm for the reconstruction of complex chest wall defects. Respiratory preservation, semirigid stabilization, and longevity are key when reconstructing chest wall defects.Learning Objectives
After viewing this course, the participant should be able to:
- Appraise and evaluate risk factors for respiratory compromise following oncologic resection.
- Outline and apply an algorithmic approach to reconstruction of the chest wall based on defect composition, size, and characteristics of surrounding tissue.
- Recognize and evaluate indications for and types of skeletal stabilization of the chest wall.
- Critically consider, compare, and select pedicled and free flaps for chest wall reconstruction that do not impair residual respiratory function or skeletal stability.
Kathryn V. Isaac, M.D.; M.P.H.Kate Elzinga, M.D.; Edward W. Buchel, M.D.
Section Editors: Donald H. Lalonde, MD; John YS Kim, MD
AMA PRA Category 1 CreditTM: 1.0
Patient Safety Credit: 0.5
Media:Journal Article, video
Release Date: 03/01/2022
Expiration Date: 03/01/2025
Estimated time to complete this course: 1 hour
*Course access ends on course expiration date
Directly provided by the American Society of Plastic Surgeons® (ASPS®)
The American Society of Plastic Surgeons (ASPS) is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians.
The ASPS designates this enduring material for a maximum of 1.0 AMA PRA Category 1 Credit™. Physicians should claim only the credit commensurate with the extent of their participation in the activity.
This educational activity is intended for plastic surgery practitioners, residents, and other healthcare professionals interested in translating expanded knowledge into practice for the improvement of patient outcomes in plastic and reconstructive surgery.Disclosures
Link to Current Disclosures
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