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Chest Wall Reconstruction St. Louis

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Patients sometimes develop defects of the chest wall that need specialized reconstruction. This may be due to a sarcoma or cancer removal. Other times a severe infection can cause damage to the bones, lungs, airways and tissues of the chest wall. Trauma and side effects from radiation treatments can also lead to significant wounds requiring coverage.

When these situations arise, our surgeons are called upon by their surgical colleagues to reconstruct these difficult wounds. This often requires moving muscles from one part of the body to the area of concern in order to fill the cavity with healthy tissue. This may entail moving a chest wall, or pectoralis, muscle to cover an infected sternal wound. Sometimes it requires a large muscle from the back, the latissimus, to fill the chest cavity after a lung resection. Other times our surgeons transfer muscles and tissue from the abdomen to complete the reconstruction.

Each situation is unique and complex. Our surgeons will spend significant time evaluating the surgical problem, recent imaging studies, and all of the patient’s medical issues. They will devise the best surgical solutions and spend time discussing this with the patient and family. Some of these operations are performed in stages with several surgeries prior to the reconstruction to ensure infection is controlled and the body ready to undergo tissue transfer. Multiple drains are often placed to help remove fluid and allow good healing. Some patients need close monitoring in the intensive care unit afterwards, and may need a period of rehabilitation at a therapy center prior to transitioning home.

QUICK FACTS:

  • Length: 3-6 hours
  • Anesthesia: General anesthesia
  • Inpatient
  • Recovery: 2-6 weeks
  • Side Effects: Weakness, tenderness, bruising, swelling

CHEST WALL RECONSTRUCTION CAN:

  • Eradicate infection
  • Fill empty space
  • Bring in healthy tissue to an area
  • Improve blood flow
  • Counter some effects of radiation
  • Improve breathing dynamics

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PREPARING FOR CHEST WALL RECONSTRUCTION

Smoking and all forms of nicotine should be stopped at least 2 weeks prior to any surgery.
This includes e-cigarrettes, patches, and gum.

Any medications and supplements which cause an increased risk of bleeding should also be stopped 2 weeks prior to any major surgery. Please see our list of medications and supplements to avoid. As always, make sure to check with your doctor before stopping any medications.

CHEST WALL RECONSTRUCTION TECHINQUE:

Our surgeons perform all major reconstructive surgeries under general anesthesia at the main St. Luke’s operating rooms. They have a team of plastic surgery assistants as well as some of the best anesthesia providers around to ensure a successful, safe reconstruction. Our surgeons will prepare the defect for tissue transfer, removing all non-viable and infected tissue. They then elevate and transfer the healthy tissue into the defect. Multiple drainage tubes are often necessary and are placed in the donor and recipient surgical sites. Multiple layers of sutures are often used to close the tissues, and sometimes skin grafts are needed.

RECOVERY CHEST WALL RECONSTRUCTION

Patients recover for several days in the hospital prior to rehabilitating at a therapy center. Once their clinical condition and strength has improved enough, they will be allowed to return home. Home health nursing is sometimes needed to assist with any residual wound or dressing care.

FREQUENTLY ASKED QUESTIONS
Do you Have a Question?

A: Yes. There will always be some weakness to the area where the muscle was removed. However, the body is quite resilient and redundant. Other adjacent muscles will often adapt and strengthen to make up for this loss.
A: This can vary greatly depending on the size of the defect, the muscles transferred to reconstruct the area, and the patient’s preexisting health status. In general, the more active someone is prior to a major surgery, the quicker he or she will recover. Patients with multiple other medical problems or who are already fairly deconditioned prior to the surgery may have a longer recovery. Some patients recover quite well within just a few days while others may take a few weeks to regain independence.

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STERNAL RECONSTRUCTION WITH MUSCLE FLAPS

Right Rectus Abdominis and Left Pectoralis Muscles

**Warning. Graphic content. Video is of an actual surgery showing muscle harvest and transfer from the abdomen and chest into a sternal defect. This video is for educational purposes.**