Pg. Arnold et Pc. Pairolero, CHEST-WALL RECONSTRUCTION - AN ACCOUNT OF 500 CONSECUTIVE PATIENTS, Plastic and reconstructive surgery, 98(5), 1996, pp. 804-810
Our experience with 500 consecutive chest-wall reconstructions over th
e past 18 years is reviewed. Of the 500 patients, 286 were male and 21
4 were female. Their ages ranged from 1 day to 85 years (average 55 ye
ars). Among the patients, 275 had chest-wall tumors, 142 had infected
median sternotomies, 119 had radiation necrosis, and 121 had combinati
ons of the three. Skeletal resection of the chest wall was done in 443
patients. An average of 3.9 ribs were resected in 241 patients. Total
or partial sternectomies were performed in 231 patients. Four-hundred
and seven performed in 231 patients. Four-hundred and seven patients
underwent 611 muscle flaps: 355 pectoralis major, 141 latissimus dorsi
, and 115 others, including serratus anterior, rectus abdominis, and e
xternal oblique. The omentum was transposed in 51 patients. Chest-wall
skeletal defects were closed with polytetrafluoroethylene soft-tissue
patch in 116 patients, polyproplene mesh in 55, and autogenous rib in
13. The 500 patients underwent an average of 2.3 operations. Hospital
ization averaged 21 days. There were 15 perioperative deaths. Twenty-t
hree patients required tracheostomy. The average duration of follow-up
was 57 months. There were 229 late deaths; the cause of death was can
cer in 147 patients, cardiac in 49, pulmonary in 7, and other in 26. F
our-hundred and three of the 485 patients (83.1 percent) who were aliv
e 30 days after the operation had excellent results and had a healed,
asymptomatic chest wall at the time of death or last follow-up. We con
clude that chest-wall reconstruction is safe, durable, and associated
with long-term survival.