The chest wall functions as a protective barrier around the body’s vital organs. Any disruption of this structure can affect circulatory and respiratory function. The abdominal wall protects the intestines and reproductive organs. Chest and abdominal wall reconstruction is a complex surgical process, and it may involve multiple procedures.
The chest wall is a complex interplay of 12 paired ribs with external and internal muscles. Protecting the lungs, liver, and heart, the chest wall provides a flexible skeletal framework that stabilizes the function of the shoulders and arms. The chest wall promotes respiratory movement, so any dysfunction can lead to life-threatening consequences. Chest wall reconstruction has improved over the last few decades, and long-term success rates are around 95%. The focus of the procedure is on the blood supply and anatomy, which involves the use of prosthetic materials when necessary. ‘
The abdominal wall consists of skin, superficial fascia, subcutaneous tissue, deep fascia, extraperitoneal fascia, muscle, and the peritoneum. The skeletal anatomy of the abdomen consists of the lower ribs, the upper region of the hips (iliac crests), the lower point of the sternum (xiphoid process), and the pubic symphysis.
Common indications for chest and abdominal wall reconstruction include:
Reconstructive surgeons have several treatment options available. These include:
A suitable candidate for the complex reconstruction of the chest and abdominal wall is anyone who:
Chest and/or abdominal wall reconstruction is a complex procedure, taking 2-7 hours depending on the severity. You will be put under a general anesthetic, and have no pain during the procedure. Because the procedure is different for every patient, expect incisions near your problem areas. Once repairs are made, incisions are closed with sutures. Bandages and a support garment will be applied after incisions are closed.
Recovery may involve a hospital stay of 2-7 days, but this depends on the extent of the procedure. You will be given antibiotics to prevent infection, and pain relievers for discomfort. You cannot participate in strenuous activities for 4-6 weeks, and must rest at home after being discharged from the hospital.
In a 5-year retrospective study, researchers found that risk factors for poor outcomes after surgery were smoking, hypertension, and chronic lung disease. However, surgical techniques and medical technology have improved over the last 50 years, with success rates of 90-99%.
The chest wall functions as a protective cage around the vital organs of the body, and significant disruption of its structure can have dire respiratory and circulatory consequences. The past several decades have seen a marked improvement in the management and reconstruction of complex chest wall defects. Widespread acceptance of muscle and musculocutaneous flaps such as the latissimus dorsi, pectoralis major, serratus anterior, and rectus abdominis has led to a sharp decrease in infections and mortality. Successful reconstructions are dependent upon a detailed knowledge of the functional anatomy and blood supply of the chest and the underlying pathophysiology of a particular disease process. This article will provide an overview of key principles and evidence-based approaches to chest wall reconstruction.
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