The Institute of Chest Wall Surgery
Surgery for A 67-year-old Patient with Chest Wall Defect
Medical History
The patient is a 67-year-old man who underwent surgery and radiation therapy for the chest wall tumor 35 years ago. After the radiation therapy, the skin at the treated area darkened but showed no ulceration. Regular follow-ups over the years confirmed no recurrence of the tumor. However, two months ago, the patient suddenly observed redness, swelling, and ulceration at the surgical site, accompanied by discharge oozing out.
Preoperative Examination
The left anterior chest wall shows a large area of chronic radiation damage, featuring fistulas accompanied by some grayish-white discharge. The overlying skin is dark brown in color. Deep within the fistulas, an obvious necrotic lesion is present, with adhesions to the pericardium. The patient was diagnosed with chest wall defect resulting from radiation therapy for the chest wall tumor.
Surgical Steps
1. The skin in the area of necrosis resulting from radiation therapy was excised to reveal the underlying lesion. The main body of the lesion was primarily located on the chest wall and extended into the thoracic cavity. It was surrounded by fibrous tissue and adhered to the pericardium. Furthermore, the left costal arch and the connected ribs had undergone necrosis.
2. The left costal arch and all necrotic bones were excised, followed by the reconstruction of the chest wall defect using MatrixRIBs, which were then encapsulated with fibrous membrane on both sides.
3. Pedicled flaps, consisting of skin tissues with attached blood vessels and nerves, were harvested from the upper left abdomen and used to cover the chest wall defect.
4. Drainage tubes were placed in the thoracic cavity and beneath the flap to drain accumulated fluid.
5. The incision was sutured, and the surgery was completed.
