ABSTRACT
The chest wall plays a role to protect vital organs in the trunk such as heart and lung, and to facilitate a semi-rigid structure for breathing. When a defect occurs in a chest wall for such reasons as trauma, tumor, infection, inflammation, post-radiation necrosis, congenital anomaly, and so forth, not only anatomical, but also functional aspects should be considered in reconstruction process. It is, generally speaking, difficult to reconstruct a chest wall defect, since these patients tend to be old aged and have underlying disease with chronic and heavily contaminated wounds which had experienced irradiation or operation. In chest wall reconstruction, the authors utilized muscle flaps in trunk to secure a semi-rigid structure, because muscle flaps in trunk are easily accessible, and have reliable blood vessels. We have conducted 42 cases of chest wall reconstruction between Feb, 1996 and Jan, 2003. Except one case, we succeeded in gaining satisfactory results in functional and anatomical aspects. Based on these experiences, we would like to clarify the principles of chest wall reconstruction as below, helping to choose a proper method in the operations. The principles are appropriate debridement, skeletal reconstruction when indicated, coverage of soft tissue with muscle flap and removal of dead spaces.