An innovative technique of chest wall stabilization and reconstruction in traumatic flail chest: The figure-of-eight suture with polypropylene mesh and musculofascial flap.

Surgical stabilization of the flail chest is challenging and has no established guidelines. Chest wall integrity and stability are the main factors that ensure the protection of intrathoracic organs and an adequate respiratory function. Here, we report a novel chest wall reconstruction technique in a 45-year-old man with a traumatic left flail chest and open pneumothorax diagnosed both clinically and radiographically. Rib approximation and chest wall reconstruction was done using intercostal figure-of-eight suture and polypropylene mesh with vascularized musculofascial flap. The patient improved gradually and was discharged after three weeks of total hospital stay. He returned to regular working after a month with no evidence of respiratory distress or paradoxical chest movement. Follow-up visit at one year revealed no lung hernia or paradoxical chest movement. This is a novel, feasible and cost-effective modification of chest wall reconstruction that can be adopted for thoracic wall repair in case of open flail chest, which needs emergency surgical interventions even in resource constraint settings.

Intercostal Muscle Cavernous Haemangioma: A Chest Wall Pandora's Box.

BACKGROUND: Haemangiomas are uncommon chest wall tumours arising outside the rib cage. Their occurrence in intercostal muscle is extremely rare. AIM: We describe a case of intercostal muscle cavernous haemangioma as a differential diagnosis for chest wall swelling. CASE DESCRIPTION: We describe an 18-year-old male patient with an asymptomatic left-sided chest wall swelling. Contrast-enhanced computed tomography revealed a well-defined homogenously non-enhancing mass lesion arising from the seventh intercostal muscle with differential diagnoses of various chest wall tumours. Clinical presentation and imaging findings were inconclusive, but histopathological examination following excision biopsy revealed a cavernous haemangioma. The present case emphasizes the importance of histopathological diagnosis when clinical and radiological examination is inconclusive. Hence, it is necessary to consider intercostal muscle haemangiomas as a differential diagnosis for chest wall tumours in the absence of a feeding vessel. CONCLUSION: Despite its rare occurrence, intercostal muscle haemangioma must be considered as a differential diagnosis in chest wall tumours even in the absence of a feeding vessel. We believe that histopathology can provide a definitive diagnosis when most investigative procedures are inconclusive. LEARNING POINTS: Haemangiomas are rare chest wall tumours and even rarer when they originate from intercostal muscle.Intercostal muscle haemangiomas should be included in the differential diagnosis of chest wall tumours even in the absence of a feeding vessel.The present case emphasizes the importance of histopathological diagnosis when clinical and radiological examinations are inconclusive.