BACKGROUND: The study was done to project the different available surgical modalities of chest wall reconstruction for different traumatic chest wall lesions.
METHODS: Sixty Patients were devided into two equal groups, 30 patients in each group. In first group, skeletal tissue reconstruction was done using plates and screws in 15 patients. In second group, soft tissue reconstruction was done using latissimus dorsi flap in 15 patients and pectoralis major flap in the other 15 patients. The mandibular plate was the type used in fixation with three interlocking screws on each side of fracture. The prolene mesh was sutured to margins of skeletal defects with interrupted prolene sutures then covered with muscle flap. The latissimus dorsi flap was used to cover lateral and anterior soft tissue defects. Also pectoralis major flap was used to cover superioanterior and upper lateral soft tissue defects. Each patient was assessed for primary outcome as ICU admission, mechanical ventilation and hospital stay. Secondary outcome as deformity, redo surgery and death.
RESULTS: The need for mechanical ventilation, ICU admission, seroma formation, redo surgery, hospital stay and deformity are more decreased in plates and screws subgroup than prolene mesh reconstruction but no difference in chest infection, wound infection and death between two subgroups. On the other hand, flap hematoma, seroma formation and residual deformity are more decreased in pectoralis major flap than latissimus dorsi flap.
CONCLUSION: fixation of fractures with metal plates and screws decrease morbidity. Most skeletal chest wall defects can be reconstructed with prolene mesh. The latissimus dorsi and pectoralis major flaps are of the most versatile and reliable flaps used in reconstruction today.
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