Abstract
Acquired chest wall defects present a challenging problem for thoracic surgeons. Many of such defects can be repaired with the use of local and regional musculocutaneous flaps, but larger defects compromising skeletal structure require increasingly sophisticated reconstructive techniques. The following discussion will review the options for repair acquired chest wall defects based in literature. The authors searched the Pubmed (www.pubmed.com) and found citations from January 1996 to February 2008. By reading the titles and the abstracts most of the citations were discharged because they focused in congenital chest wall defects or were cases report. However, many papers were found describing the outcome of large series of patients with acquired chest wall deformities. A review of recent literature shows that the repair of chest wall defects with soft tissues, if possible, remains the treatment of choice. Large chest wall defects require skeletal reconstruction to prevent paradoxical respiration. The selection of the most appropriate flap is primary dictated by the location and the size of the defect. It is important to transfer tissue with good vitality, so understanding the vascular supply is imperative. Autogenous grafts have been used in the past for skeletal reconstruction but a combination of synthetic materials with musculocutaneous flaps has been used lately. Based in the literature, the use of prosthetic material in chest wall reconstruction does not significantly increases the risk of wound infection.
Highlights
Acquired chest wall defects present a challenging problem for thoracic surgeons
Many of such defects can be repaired with the use of local and regional musculocutaneous flaps, but larger defects compromising skeletal structure require increasingly sophisticated reconstructive techniques
The following discussion will review the options for repair acquired chest wall defects based in literature
Summary
A infecção pode resultar em defeito da parede torácica diretamente, ou processos cirúrgicos para tratamento da infecção podem deformar a parede (por exemplo, pleurostomia). Os defeitos da parede torácica também podem ser secundários a tumores, a procedimentos cirúrgicos com grandes ressecções ósseas e/ou musculares ou à irradiação para tratamento de neoplasias. Para encontrar artigos que pudessem contribuir para uma revisão e atualização sobre as causas mais freqüentes dos defeitos adquiridos da parede torácica e das técnicas atuais para correção desses defeitos foi acessado o sítio especializado de busca www.pubmed.gov. A grande maioria dessas citações não foi aproveitada porque eram artigos que se referiam a defeitos congênitos da parede torácica, também não pertinentes ao objetivo deste trabalho, que pretendeu enfocar somente os defeitos adquiridos. Apesar de serem considerados pertinentes, não foram incluídos porque cinco deles foram escritos na língua japonesa, três na língua alemã, um na língua lituana e outro na língua chinesa
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