ABSTRACT
I. INTRODUCTION The first known chest wall resection was performed in 1778 by Aimar, which involved an osteosarcoma of the ribs (1). Parham in 1899 reported the first resection of a chest wall tumor in the United States. He excised three ribs with the tumor and narrowly avoided pneumothorax by rapid closure of the soft tissue defect (I). Later operations described filling of pleural defects with gauze and wet towels so that the patients could survive until a later closure could be designed (2). Mortality at the beginning of the 20th century was reported at 20% due to sepsis and pleural injury (3,4). The availability of endotracheal ventilation, closed chest drainage, and antibiotics decreased the risk of these resections (5), leading to the first successful pneumonectomy by Graham and Singer and further classification of chest wal1 tumors (6). The management of chest
.wall trauma in World War II resulted in the creation of algorithms for handling chest wal1 injuries. Modern surgical techniques of managing chest wal1 tumors were not developed until the 1960s. With the evolution of new methods of reconstruction, acceptable morbidity and mortality rates were final1y achieved (5). Early reconstructions employed random-pattern flaps that were prone to necrosis, resulting in complications that were not wel1 tolerated. Flap techniques developed over the years have made closure of chest wal1 defects easier and more reliable. Axial pattern muscle, myocutaneous, and fasciocutaneous pedicled flaps have a reliable intrinsic blood supply that permit immediate reconstruction. These have become the mainstays of routine reconstruction of chest wall defects following extirpation and radiation. With
the advent of microsurgery, it has become possible to do single-stage reconstruction of defects with greater magnitude and complexity than ever before. Given the wide array of local options for chest coverage, indications for microsurgical chest wall reconstruction should be limited to specific conditions, as outlined in this chapter.
