A general algorithm for chest wall reconstruction based on a retrospective review

Background Many chest wall reconstruction algorithms have been proposed, but there is still no general consensus. The purpose of this study is to review our single institutional experience in chest wall reconstruction and identify a working algorithm based on our retrospective analysis. Methods This is a retrospective analysis of 54 patients who underwent chest wall reconstruction in our department from 1996 to 2011. Results The mean follow-up was 38 months. Central chest wall defects were the most common, while infection and tumour resection were the two most common indications. The pedicled latissimus dorsi flap was a versatile flap, used as a single or combination flap for anterolateral, lateral and posterior defects. The pectoralis major flap was suitable for central and anterolateral defects and the rectus abdominis flap for lower central defects. Omentum flaps were useful in radiation-damage skin or in patients with recurrent infection. Conclusions Locoregional flaps are the mainstay of chest wall reconstruction. Most skeletal reconstruction, when required, is safely accomplished with the use of prosthetic materials. Free flaps are usually only indicated for large defects or when regional flaps are unavailable. Level of Evidence: Level IV, therapeutic study.