Chest reconstruction: I. Anterior and anterolateral chest wall and wounds affecting respiratory function

Learning Objectives: After studying this article, the participant should be able to: 1. Describe the indications for chest wall reconstruction. 2. Understand the function of the chest wall and implications for both reconstruction and the chest wall itself when components are missing or used for reconstruction. 3. List the reconstructive requirements of chest wall wounds. 4. Identify flaps for regional reconstruction of the chest wall. 5. Describe the role of microvascular surgery in chest wall reconstruction. Background: Chest wall and mediastinum wounds may be life-threatening. They interfere with respiratory mechanics and may also be contaminated with exposed vital structures. Consideration is given to flap choice to restore function, resolve infection, and maintain suitable aesthetics. Methods: Literature search as well as the authors' personal experience enabled preparation of this article. Results: Where necessary, skeletal integrity must be restored, generally with prosthetic material, and then covered with well-vascularized soft tissue. "Living tissue" is required to help combat infection, buttress visceral repairs, and fill dead space. Soft-tissue deficiency must occasionally be augmented with large distant microvascular flaps. Conclusion: Flap reconstruction has reduced morbidity and mortality of these complex problems without undue donor-site impairment of respiratory and upper extremity function.