Chest Wall Defect


Chest Wall Defect

Gwendolyn Hoben & Ida K. Fox
A 46-year-old woman with a history of right breast cancer and radiation therapy. She presents with an open chest wound and exposure of several ribs.


  • Large chest wall defect, including the inferior portion of the pectoralis major, lateral portion of the serratus, and the fourth and fifth ribs.

  • Clear evidence of osteomyelitis (with exposed, necrotic bone).

  • Healthy-appearing tissue in lateral wound.

  • Left mastectomy scar.



  • Coronary artery disease

    • History of coronary artery bypass grafting: Possible absence of internal mammary artery.

  • Pulmonary disease (chronic obstructive pulmonary disease [COPD], asthma): Increased risk for respiratory compromise in the absence of chest wall skeletal reconstruction.

  • Previous history of chest, back, or abdominal surgery/trauma: Potential compromise of specific flaps.

  • Other comorbidities.

  • Tobacco use.

  • Nutritional status.

  • Etiology of chest wall wound/deformity

    • Traumatic, oncologic, infectious, radiation, congenital.

    • If oncologic, benign versus malignant: History of (or plan for) radiation therapy.

Physical examination

  • Define defect or mass: Location, depth, fixed or mobile.

  • Perform lymph node examination.

  • Assess muscle involvement in the chest: Is the pectoralis major involved?

  • Assess abdomen for hernias, diastasis recti.

  • Evaluate back musculature and soft-tissue laxity.

  • Assess for chest wall, back, or abdominal scars.

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Jun 18, 2020 | Posted by in General Surgery | Comments Off on Chest Wall Defect
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