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Chest Wall Reconstruction

History of the Procedure

The history of chest wall reconstruction illustrates the challenges associated with this type of repair. In 1778, Aimar resected the first osteosarcoma of the ribs. In 1820, Cittadini reported a case of bony chest wall tumor resection. Parham, in 1899, was the first in the United States to report resection of a bony chest wall tumor involving 3 ribs. This apparently caused a pneumothorax, which was controlled with soft tissue coverage. In the early 1900s, Fell and O’Dwyer described intubation techniques and positive-pressure ventilation.

The image below is a postoperative photo of chest wall reconstruction.

Postoperative photo, chest wall reconstruction.

Postoperative photo, chest wall reconstruction.

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In 1906, Tansini used the latissimus dorsi myocutaneous flap, apparently for the first time, for coverage of radical mastectomy defects.
Hutchins and Campbell shared this approach.
Graham and Singer were the first to successfully perform a pneumonectomy in the early 1930s.
In the 1940s, Watson and James used the fascia lata for closure of skeletal wound defects.
Bisgard and Swenson described the use of ribs for closure of sternectomies.

Pickrell offered techniques in chest wall resection for breast cancer,
and Maier described his use of cutaneous flaps for patients with breast cancer postresection.
The 1950s and 1960s included refinement of the reconstructive techniques and the implementation of multistaged procedures. Other pioneers of mention include Arnold and Pairolero, whose studies concluded that chest wall reconstruction is safe, durable, and associated with long-term survival.
For the past 25 years, chest wall reconstruction has undergone a vast growth in technique and alternatives. Flaps often used for this task are the latissimus dorsi, pectoralis major, serratus anterior, rectus abdominis, external oblique, and omentum.

The congenital defect of the thorax, Poland syndrome, was described by Sir Alfred Poland in 1841.
He noted restricted musculature on one side of the thorax on a single autopsy. In his report entitled “Deficiency of the pectoralis muscle,” he described absence of the sternocostal portion of the pectoralis major, an absent pectoralis minor, and a severely hypoplastic serratus anterior and external oblique.
de Haan associated the defects of Poland syndrome to the overlooked concomitant deformities of the ipsilateral upper extremity and hand.

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