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Anatomy of the thoracic skeleton. Netter illustration used with permission of Elsevier, Inc. All rights reserved.
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... thoracic skeleton of the thoracic cage consists of 12 ribs and the costal cartilage, the thoracic vertebrae and the sternum (Figure 1). The sternum consists of three parts: the manubrium, body and xiphoid process. ...
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... different centres have adopted varying definitions of the surgical margins to guide their clinical practices. The resection in the chest wall can be partial thickness (Figure 9 and 10) or full thickness (Figure 11). A full-thickness resection extends into all layers of the chest wall, whilst a partialthickness resection includes either only soft-tissue resections or only skeletal bone resections (Tukiainen 2013). ...
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... different centres have adopted varying definitions of the surgical margins to guide their clinical practices. The resection in the chest wall can be partial thickness (Figure 9 and 10) or full thickness (Figure 11). A full-thickness resection extends into all layers of the chest wall, whilst a partialthickness resection includes either only soft-tissue resections or only skeletal bone resections (Tukiainen 2013). ...
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... isolated diaphragm resection is seldom performed for oncological reasons, because the primary or secondary tumour rarely grows in the diaphgram (Baldes, Schirren 2016). Typically, a diaphragm resection and reconstruction represents a part of the procedure in a thoracoabdominal wall tumour (Figure 12) resection (Mansour, Thourani et al. 2002) or in an extrapleural pneumonectomy or pleurectomy decortication due to mesothelioma (Bassuner, Rice et al. 2017). The diaphragm separates the thoracic and abdominal cavity, providing a natural border between these two structures and helping to achieve wide margins in an oncological resection surgery (Tukiainen 2013). ...
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... stabilisation is achieved through the use of a bioprosthetic matrix or synthetic mesh ( Figure 13) (Althubaiti, Butler 2014). Specifically, for large or extensive anterior or anterior-lateral defects, more rigid stabilisation can be achieved using techniques such as the sandwich method technique (methylmethacrylate sandwiched between two layers of mesh; Figure 14) (Lardinois, Muller et al. 2000), a rib graft with mesh, titanium plates (Berthet, Canaud et al. 2011) and titanium mesh (Tamburini, Grossi et al. 2019, Yang, H., Tantai et al. 2015). ...
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... stabilisation is achieved through the use of a bioprosthetic matrix or synthetic mesh ( Figure 13) (Althubaiti, Butler 2014). Specifically, for large or extensive anterior or anterior-lateral defects, more rigid stabilisation can be achieved using techniques such as the sandwich method technique (methylmethacrylate sandwiched between two layers of mesh; Figure 14) (Lardinois, Muller et al. 2000), a rib graft with mesh, titanium plates (Berthet, Canaud et al. 2011) and titanium mesh (Tamburini, Grossi et al. 2019, Yang, H., Tantai et al. 2015). A history of radiation to the defect area impacts the stability of the chest wall. ...
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... fibrous provides more stability, diminishing the need for chest wall stabilisation with mesh in some cases (Losken, Thourani et al. 2004). In large full-thickness chest wall defects, stabilisation combined with soft-tissue reconstruction is necessary (Figure 14). The size and location of the chest wall defect, the availability of local and pedicled flaps, previous operations or radiotherapy and the general condition and prognosis of the patient all impact the choice of soft-tissue flap reconstruction. ...
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... chest wall stabilisation in skeletal bony defects, soft-tissue flap reconstruction is not obligatory if the primary closure can be achieved using healthy, well-vascularised soft tissue. In partial-thickness soft-tissue defects, a soft-tissue flap reconstruction is adequate (Figure 15). Skin graft is rarely used given that it is unable to cover exposed bone, cartilage or prosthesis (Tukiainen 2013). ...
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... sandwich technique (Figure 12, page 34) relies on two meshes shaped slightly larger than the defect. Then, MMA or PMMA is added between two layers of mesh, thereby creating a sandwich. ...
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... latissimus dorsi muscle or latissimus dorsi musculocutaneous (Figure 16) flap has been used as a workhorse flap in several surgical series for chest wall reconstructions (Mansour, Thourani et al. 2002, Chang, Mehrara et al. 2004, Deschamps, Tirnaksiz et al. 1999, Arnold, Pairolero 1996. Given the large volume of the latissimus dorsi muscle flap, it is commonly used to eliminate dead space accompanying intrathoracic defects (Chen, Bonneau et al. 2016, Arnold, Pairolero 1989 since damage to the muscle should be avoided during routine thoracotomy. ...
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... cases where the typical recipient vessels are unavailable or the flap positioning is extremely impractical, an arteriovenous (A-V) loop remains a solid option for gaining in-and outflow to the flap. The saphenous loop (Figure 17) from the lower leg is used as the recipient vessel to achieve good blood flow to the flap and to relieve positioning of the flap in the thoracoabdominal region (Tukiainen, Popov et al. 2003). Engel et al. used an A-V loop between the cephalic vein-thoracoacromial artery (CTA) loop in chest wall reconstructions (Engel, Pelzer et al. 2007). ...
Context 12
... the donor site must be covered with a skin graft if primary closure is impossible, although this is normally acceptable in this group of patients who have a malignant, large tumour removed. When a long and wide flap (Figure 18) is needed (including a skin island extending distally close to the knee), distal tip necrosis can develop in the flap. To overcome this, a muscle (vastus lateralis or rectus femoris) can be included in the flap. ...
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... diaphragm provides a natural barrier to achieving wide surgical resection margins if a malignant tumour is located on the thoracoabdominal wall just above or below the diaphragm ( Figure 21). After a radical en-bloc resection of the thoracoabdominal wall and diaphragm, reconstruction is necessary. ...
