Pectus excavatum in motion: dynamic evaluation using real-time MRI.

OBJECTIVES: The breathing phase for the determination of thoracic indices in patients with pectus excavatum is not standardized. The aim of this study was to identify the best period for reliable assessments of morphologic indices by dynamic observations of the chest wall using real-time MRI. METHODS: In this prospective study, patients with pectus excavatum underwent morphologic evaluation by real-time MRI at 3 T between January 2020 and June 2021. The Haller index (HI), correction index (CI), modified asymmetry index (AI), and modified eccentricity index (EI) were determined during free, quiet, and forced breathing respectively. Breathing-related differences in the thoracic indices were analyzed with the Wilcoxon signed-rank test. Motion of the anterior chest wall was analyzed as well. RESULTS: A total of 56 patients (11 females and 45 males, median age 15.4 years, interquartile range 14.3-16.9) were included. In quiet expiration, the median HI in the cohort equaled 5.7 (4.5-7.2). The median absolute differences (Δ) in the thoracic indices between peak inspiration and peak expiration were ΔHI = 1.1 (0.7-1.6, p < .001), ΔCI = 4.8% (1.3-7.5%, p < .001), ΔAI = 3.0% (1.0-5.0%, p < .001), and ΔEI = 8.0% (3.0-14.0%, p < .05). The indices varied significantly during different inspiratory phases, but not during expiration (p > .05 each). Furthermore, the dynamic evaluation revealed three distinctive movement patterns of the funnel chest. CONCLUSIONS: Real-time MRI reveals patterns of chest wall motion and indicate that thoracic indices of pectus excavatum should be assessed in the end-expiratory phase of quiet expiration. KEY POINTS: • The thoracic indices in patients with pectus excavatum depend on the breathing phase. • Quiet expiration represents the best breathing phase for determining thoracic indices. • Real-time MRI can identify different chest wall motion patterns in pectus excavatum.

Conventional ultrasound combined with contrast-enhanced ultrasound: could it be helpful for the diagnosis of thoracic wall recurrence after mastectomy?

OBJECTIVES: To develop a predictive model using conventional ultrasound combined with CEUS to identify thoracic wall recurrence after mastectomy. METHODS: A total of 162 women with pathologically confirmed thoracic wall lesions (benign 79, malignant 83; median size 1.9 cm, ranging 0.3-8.0 cm) underwent a mastectomy and were checked by both conventional ultrasound and CEUS and were retrospectively included. Logistic regression models of B-mode ultrasound (US) and color Doppler flow imaging (CDFI) with or without CEUS were established to assess the thoracic wall recurrence after mastectomy. The established models were validated by bootstrap resampling. The models were evaluated using calibration curve. The clinical benefit of models were assessed using decision curve analysis. RESULTS: The area under the receiver characteristic was 0.823 (95% CI: 0.76, 0.88) for model using US alone, 0.898 (95% CI: 0.84, 0.94) for model using US combined with CDFI, and 0.959 (95% CI: 0.92, 0.98) for model using US combined with both CDFI and CEUS. The diagnostic performance of the US combined with CDFI was significantly higher than that of the US alone (0.823 vs 0.898, p = 0.002) but significantly lower than that of the US combined with both CDFI and CEUS (0.959 vs 0.898, p < 0.001). Moreover, the unnecessary biopsy rate of the US combined with both CDFI and CEUS was significantly lower than that of the US combined with CDFI (p = 0.037). CONCLUSIONS: Compared to B-mode ultrasound and CDFI, CEUS improves the diagnostic performance to evaluate thoracic wall recurrence after mastectomy. KEY POINTS: • CUES is an effective supplementary method for US in the diagnosis of thoracic wall recurrence after mastectomy. • CEUS combined with both US and CDFI can significantly improve the accuracy of diagnosis of thoracic wall recurrence after mastectomy. • CEUS combined with both US and CDFI can reduce the rate of unnecessary biopsy of thoracic wall lesions after mastectomy.

Intraoperative Fascial Plane Blocks Facilitate Earlier Tracheal Extubation and Intensive Care Unit Discharge After Cardiac Surgery: A Retrospective Cohort Analysis.

OBJECTIVES: Novel fascial plane blocks may allow early tracheal extubation and discharge from the intensive care unit (ICU). The present study primarily aimed to determine whether fascial plane blocks, in comparison with intravenous analgesia alone, significantly shortened tracheal extubation times in patients undergoing cardiac surgery. The secondary objectives were to compare each block's performance with that of intravenous analgesia alone in terms of the individual tracheal extubation time and length of ICU stay. DESIGN: Retrospective observational study. SETTING: Single-center study. PARTICIPANTS: Patients who underwent cardiac surgery between 2018 and 2019 were identified from a prospective clinical registry. After obtaining ethics approval, the clinical and electronic records of patients undergoing cardiac surgery in 2018 were analyzed. Data of patients receiving fascial plane blocks (erector spinae plane [ESP], pectoral plane I and II [PECs], and serratus anterior plane [SAP] blocks) with intravenous analgesia were compared with those of patients receiving only intravenous analgesia. A propensity score (PS) model was used to control for differences in the baseline characteristics. Adjusted p < 0.05 was considered statistically significant. MEASUREMENTS AND MAIN RESULTS: Of the 589 patients screened, 532 met the inclusion criteria; 404 received a fascial plane block. After PS matching, weighted linear regression revealed that by receiving a block, the predicted extubation time difference was 9.29 hours (b coefficient; 95% CI: -11.98, -6.60; p = 0.022). Similar results were obtained using PS weighting, with a reduction of 7.82 hours (b coefficient; 95% CI: -11.89, -3.75; p < 0.001) in favor of the block. In the fascial-plane-block group, ESP block achieved the best performance. The length of ICU stay decreased by 1.1 days (b coefficient; 95% CI: -1.43, -0.79; p = 0.0001) in the block group. No complications were reported. CONCLUSIONS: Fascial plane block is associated with reduced extubation times and lengths of ICU stay. ESP block achieved the best performance, followed by PECs and SAP blocks. After PS matching, only ESP block reduced the extubation time.

Dynamic musculoskeletal ultrasound: slipping rib, muscle hernia, snapping hip, and peroneal tendon pathology.

Dynamic musculoskeletal ultrasound is an important diagnostic tool that allows the practitioner to observe soft tissue structures over a range of motion and identify pathology not diagnosed on other modalities. Familiarity with this modality allows health care practitioners to appropriately refer patients for this type of examination. This article will review several indications for dynamic ultrasound imaging, including slipping rib, muscle hernia, snapping hip, and peroneal tendon pathology. The examination technique and expected findings for common pathology in each location are discussed.

Case Report Of Rib Polyostotic Fibrous Dysplasia.

Polyostotic fibrous dysplasia is a rare benign asymptomatic tumour of the ribs not requiring surgery on most occasions. We present here a case with left 10th and 11th rib fibrous dysplasia which was causing a hinderance to the Urologist for renalstone extraction. Therefore the 10th and 11th ribs were excised followed by chest wall reconstruction.

Utilizing the visual analogue scale (VAS) to monitor and manage pain in post-operative skin wounds after thoracic surgery.

Due to the global increase in thoracic interventions, there is greater emphasis on refining post-operative care. The purpose of this study was to validate the visual analogue scale (VAS) as the valid method for measuring post-operative pain in thoracic surgery patients. From January 2020 to June 2022, this cross-sectional study investigated 240 adult patients who underwent elective thoracic surgeries in Thoracic Surgery Department of Heilongjiang Provincial Hospital. The participants were instructed to rate their discomfort using VAS at predetermined intervals after surgery. The following demographic and clinical information was recorded: age, gender, type of thoracic surgery, and history of chronic pain. Results showed a progressive decline in post-operative VAS scores over 72 h: 8.2 immediately after surgery, 6.0 at 24 h, 5.4 at 48 h, and 3.6 by 72 h. There were notable correlations between VAS scores and chronic pain history, with moderately positive correlation of 0.40 being observed. Mean scores for males and females were 3.8 and 3.9, respectively. The analysis by age revealed comparable mean scores for age categories below and above 40. With the exception of thoracic wall resection, which resulted in an average VAS score of 4.1 ± 1.0 (p < 0.05), the type of surgery had the minimal effect on variability of pain scores. The VAS is a reliable method for evaluating post-thoracic surgery discomfort. Given the substantial impact of pain history on VAS scores, there is an urgent need for personalized pain management strategies to improve post-operative care.

Anatomical basis of retrograde thoracic veins flow and its implications in complex thoracic wall reconstructive surgery.

PURPOSE: Internal thoracic veins are increasingly used as recipient's vessels in chest wall reconstructive surgery due to their predictable anatomy and to the possibility to make a double venous anastomosis, exploiting the retrograde flow within them. Over the years, retrograde flow had been explained by the absence of valves in internal thoracic veins, which have been found recently instead. Therefore, our aim is to analyze the retrograde flow and its relationship with valves in the internal thoracic veins. METHODS: We evaluated 32 internal thoracic veins of 16 fresh-frozen specimens with undamaged thoracic cages by dynamic analysis focused on retrograde flow assessment through a partial external circulation system obtained cannulating the subclavian veins. Gross anatomical and morphological evaluations about the presence of valves and their pattern were then made. RESULTS: Efficient, partial, and absent retrograde flow was, respectively, found in 17/30, 8/30 and ITVs and 5/30 internal thoracic veins. Following Arnez's classification, 20/32 Type I and 12/32 Type II internal thoracic veins were identified. Valves were observed in 10/16 specimens (62.50%) corresponding to 36.67% of examined veins (11/30). Three valves were found between the 2nd intercostal space and 12 valves in the 3rd intercostal space. 13/15 valves were bicuspid, 2/15 tricuspid. A significant correlation (p < 0.001) between the retrograde flow and the presence of valves in internal thoracic veins was observed. CONCLUSION: Our study suggests a possible influence of the presence and the number of valves in the efficient retrograde flow of the internal thoracic veins, suggesting that, especially for more complex cases, a preoperative or intraoperative evaluation of the chest wall drainage should be recommended.

Does the use of BariBoard™ improve adequacy of chest compressions in morbid obesity? A pilot study using a simulation model.

BACKGROUND: Obesity is a growing health problem worldwide. Morbid obesity has been associated with significant barriers to effective thoracic cage compression during cardiopulmonary resuscitation. OBJECTIVE: The BariBoard™ purports to improve adequacy of chest compressions in morbidly obese patients. This study uses a simulation model to evaluate this. METHODS: This was a prospective blinded randomised-controlled crossover pilot trial using a simulation model of obesity. Participants, recruited from hospital departments and prehospital services, performed 2 minutes of continuous compressions on mannequins modified to emulate a morbidly obese patient. Participants were randomised by coin toss to a sequence of either control/intervention or intervention/control, with the BariBoard™ in the intervention arm. Accelerometers measured chest wall movement during compressions. The primary endpoint was a composite measure of compression adequacy (rate, depth, and recoil). Secondary endpoints comprised the individual components of the composite outcome, as both dichotomous outcomes (adequate vs. inadequate) and continuous variables. All endpoints were adjusted for potential confounders. RESULTS: Of 205 participants recruited, 201 were analysed. There was a significant difference in the primary outcome between the control and intervention arms (13.4% vs. 4.5%, respectively, p = 0.001) and between the control and intervention arms for the secondary endpoints of adequate compression depth (31.3% vs. 15.9%, p < 0.001) and recoil (63.7% vs. 41.3%, p < 0.001). After adjustment for confounders and interactions, there was no difference in overall efficacy (odds ratio: 0.62, 95% confidence interval: 0.20-1.90, p = 0.40). CONCLUSION: This pilot study describes the successful assessment of a device using a simulation model of obesity. Within these constraints and after adjustment for confounders, use of the BariBoard ™ did not improve efficacy of chest compressions.

Tract metastasis in patients with long-term pleural catheter-computed tomography diagnosis and longitudinal assessment.

OBJECTIVES: Long-term indwelling pleural catheters (IPC), used for the management of malignant pleural mesothelioma (MPM), may lead to catheter tract metastasis (CTM). While computed tomography (CT) is valuable for diagnosis, no studies have assessed CT manifestations of CTM. Our goal is to describe the incidence, CT appearances, and temporal evolution of CTM in MPM. METHODS: A retrospective review of CT of 90 consecutive patients with MPM and IPC. In patients with CTM, a longitudinal assessment was performed for CT appearance at diagnosis and over time, interval from insertion to diagnosis and rate of progression. RESULTS: The incidence of CTM was 26% (23/90), in 22 men (54-83 years, mean 73 years). CTM manifested with focal lesion (3 to 60 mm, mean 25 mm) in the subcutaneous tissue at the insertion site. Abnormalities of sub-adjacent skin and fat stranding were present in 16/24 (66%) and 11/24 (46%), respectively, enlargement of chest wall musculature in 11/24 (46%), and dilated subcutaneous vessels in 4/24 (17%) patients. On follow-up, 53% had enlargement of focal lesion. The average rate of progression was 3.5 mm/month, compared to 0.79 mm/month for pleural thickening (p = 0.03). The time between IPC insertion and CTM diagnosis varied from 58 to 1375 days (median 408 days); 83% occurred after IPC removal. Reporting radiologists described focal abnormality at the insertion site in only 9/23 (39%) patients. CONCLUSIONS: CTM is commonly overlooked and underreported by radiologists. CT invariably demonstrates focal subcutaneous lesion in the procedure tract, most commonly after IPC removal. Ancillary findings, notably serratus or latissimus dorsi muscle enlargement, are novel finding that can assist in CT detection and diagnosis. KEY POINTS: • Catheter tract metastasis (CTM), resulting from indwelling pleural catheter to manage malignant pleural mesothelioma, invariably manifested on CT as a focal subcutaneous lesion at the site of insertion, more commonly after catheter removal. • Ipsilateral muscle enlargement is a newly described CT finding that can assist in the detection and diagnosis. • Catheter tract metastasis was commonly overlooked by radiologists, reported in only 39% of cases.

Congenital dermoid sinus of the anterior chest region.

BACKGROUND: Congenital dermoid sinus of the anterior chest region (CDACR) is a rare developmental anomaly. Therefore, the aim of our study was to draw attention to this underrecognized lesion. METHODS: From 2011 to 2019, our study group included 11 patients who presented to our hospital with pits and masses of their anterior chest walls. All lesions were surgically excised with histologic confirmation of the diagnosis of CDACR. The medical records of these patients were reviewed for the following data: patient age, gender, clinical characteristics of the lesion and site of involvement, department first visited, diagnostic evaluation, management, postoperative complications, and histopathological findings. RESULTS: There was a clear left-sided predominance, with 10/11 cases occurring on the left and a female predominance of eight cases out of 11. Although the pits were present at birth, the mean age at presentation was 19.7 months. All patients showed clinical signs of infection at the time of presentation and were treated with antibiotics. Seven patients had a history of abscess formation treated with incision and drainage. Ultrasound was performed in eight patients. In all cases, the lesions, including pit and sinus, were completely excised. CONCLUSIONS: Congenital dermoid sinus of the anterior chest region is likely underrecognized. We encountered a high frequency of complications such as infections or abscesses prior to surgical excision. Complete excision of CDACR is not technically difficult. Therefore, surgical removal should be considered, even for asymptomatic lesions, to avoid future complications and for cosmesis.

Pediatric rib pathologies: clinicoimaging scenarios and approach to diagnosis.

Pathologies involving the ribs are diverse in nature, including entities specific to the pediatric population as well as shared pathologies with adults. These can be either localized within or adjacent to the rib, but may also cause rib alteration as a component of a systemic process. To better understand these disorders, we discuss several common rib pathologies in the context of their clinical presentation and pertinent imaging findings. In addition, we review the imaging modalities that may be used to evaluate the ribs. Encompassing both the clinical and imaging aspects of pediatric rib pathologies, this review aims to increase pediatric and musculoskeletal radiologists' awareness of the spectrum of disease and how to leverage a pattern-based approach.

Reconstruction of Extensive Chest Wall Defects Using Light-Weight Condensed Polytetrafl uoroethylene Mesh - Case Reports.

Tumors of the chest wall require extensive surgical intervention, which includes radical resection of the tumor mass followed by reconstruction of the defect. The depth of the defects may vary from a shallow one to a deep defect with exposure of the internal organs. In reconstruction of the chest wall, it is important to ensure the stability of the chest. Advanced synthetic biomaterials in combination with flap surgery are nowadays used as a treatment method of choice. The main advantage of biomaterials is easy manipulation, good fixation and a porous membrane. They are generally well tolerated by the patient. Flap surgery including regional flaps, pedicled flaps and free flap transfer are used for final closure of a deep defect. Shallow defects may be covered by autologous split-thickness skin graft transplantation. We present a series of case reports where we used light-weight condensed polytetrafluoroethylene (cPTFE) Omyra® Mesh TX B. Braun in combination with flap surgery for reconstruction of the chest wall. Different flaps for closure of the defects were used. In all cases the reconstruction of the chest wall was sufficient. One of the keys to success is a good cooperation between the oncosurgeon and the plastic surgeon.

Chest Wall Mobility: Identification of Underlying Predictors.

OBJECTIVE: The purpose of this study was to identify factors contributing to normal mobility or hypermobility of the chest wall. METHODS: Seventy-eight young adults were divided into 2 groups: patients with normal mobility (group 1, n = 40) and hypermobility of the chest wall (group 2, n = 38). The mean mobility of the chest wall in groups 1 and 2 was 9.9 and 6.1 cm, respectively. The mean age of groups 1 and 2 was 22.2 and 21.5 years, respectively. The Brief Symptom Inventory, State-Trait Anxiety Inventory, Beck Depression Inventory, and the Perceived Stress Scale were used to evaluate the psychometric properties. Quality of life was assessed using 12-Item Short Form Health Survey. Smoking status was determined via self-report of current smoking status. Chest wall mobility was measured using thoracic and axillary cirtometry. Pulmonary functions were evaluated using a Spirobank II device. Subsequently, forced vital capacity (FVC), forced expiratory volume in 1 second, peak expiratory flow, and forced expiratory flow 25% to 75% were verified. Carefusion Micro RPM and the 6-minute walk test were used to evaluate maximal respiratory pressures and functional capacity, respectively. RESULTS: With backward linear regression models, FVC and obsessive-compulsive traits were significant predictors of chest wall mobility (R²â€¯= 0.27; P < .001 and P = .01, respectively). In logistic regression models, FVC, maximum inspiratory pressure, and obsessive-compulsive traits were significant predictors of normal mobility/hypermobility of the chest wall (R²â€¯= 0.42; P < .001, P = .01, and P = .03, respectively). CONCLUSION: Forced vital capacity, maximum inspiratory pressure, and obsessive-compulsive traits are significant predictors of chest wall mobility and normal mobility or hypermobility of the chest wall.

Primary Thoracic Wall Hydatid Cyst Extended to the Abdominal wall: A Case Report.

Hydatid disease (HD) is an infectious disease caused by echinococcosis. Hydatid cyst (HC) most commonly invades the liver (60-70%) and the lungs (20-25%). However, other parts of the body and even unusual locations can be infected, mimicking a benign lesion that could be easily missed. Primary HC of the chest wall is extremely rare, even in countries where echinococcosis is endemic. We herein present a case of a 40-year-old man with a right-sided growing thoracic wall mass. The patient did not present the relevant history (living in rural areas or being in contact with farm animals) and the serological examination with the indirect hemagglutination test was negative. During surgery, a cystic mass between the eleventh and twelfth ribs was observed. The thoracic wall mass extended to the posterior abdominal wall and was entirely extrapulmonary and extraperitoneal. All cystic structures of the thoracic wall and intrathoracic region were removed, and the primary defect was reconstructed. In endemic areas such as Iran, HD should be considered in the differential diagnosis of mass lesions located in the chest wall or other parts of the body, even without the relevant history or serologic evidence.

Review of Procedures for Reconstruction of Soft Tissue Chest Wall Defects Following Advanced Breast Malignancies.

The purpose of this article is to review closure options for complex chest wounds in patients with locally advanced breast cancer. Experiences of the plastic and oncologic surgery teams at Moffitt Cancer Center were reviewed, and the literature researched for various surgical options of complex chest wound closure. Multiple treatment modalities exist for reconstruction of complex chest wall wounds with the external oblique and V-Y latissimus dorsi musculocutaneous advancement flaps serving as workhorses in reconstruction. Treatment of cancer has moved from simply a surgical solution to include other modalities such as hormonal therapy, chemotherapy, and radiation-the latter 2 having serious consequences for wound healing. A team approach and knowledge of available flap options are vital for closure of complex wounds in a timely manner. Appropriate planning can optimize the primary goal of the oncologic surgeon to remove the cancer and the plastic surgeon's objective to reconstruct the defect and achieve a closed, durable wound prior to chemotherapy and radiation. We present the experience at the Moffitt Cancer Center in reconstructing challenging chest defects and review the reconstructive ladder.

Designing strategies to implement a blunt chest injury care bundle using the behaviour change wheel: a multi-site mixed methods study.

BACKGROUND: Blunt chest injury can lead to significant morbidity and mortality if not treated appropriately. A blunt chest injury care bundle was to be implemented at two sites to guide care. AIM: To identify facilitators and barriers to the implementation of a blunt chest injury care bundle and design strategies tailored to promote future implementation. METHODS: 1) A mixed-method survey based on the theoretical domains framework (TDF) was used to identify barriers and facilitators to the implementation of a blunt chest injury care bundle. This survey was distributed to 441 staff from 12 departments across two hospitals. Quantitative data were analysed using SPSS and qualitative using inductive content analysis. 2) The quantitative and qualitative results from the survey were integrated and mapped to each of the TDF domains. 3) The facilitators and barriers were evaluated using the Behaviour Change Wheel to extract specific intervention functions, policies, behaviour change techniques and implementation strategies. Each phase was assessed against the Affordability, Practicability, Effectiveness and cost-effectiveness, Acceptability, Side-effects or safety and Equity (APEASE) criteria. RESULTS: One hundred ninety eight staff completed the survey. All departments surveyed were represented. Nine facilitators and six barriers were identified from eight domains of the TDF. Facilitators (TDF domains) were: understanding evidence-informed patient care and understanding risk factors (Knowledge); patient assessment skills and blunt chest injury management skills (Physical skills); identification with professional role (Professional role and identity); belief of consequences of care bundle (Belief about consequences); provision of training and protocol design (Environmental context and resources); and social supports (Social influences). Barriers were: not understanding the term 'care bundle' (Knowledge); lacking regional analgesia skills (Physical skills); not remembering to follow protocol (Memory, attention, and decision processes); negative emotions relating to new protocols (Emotions); equipment and protocol access (Environmental context and resources). Implementation strategies were videos, education sessions, visual prompt for electronic medical records and change champions. CONCLUSIONS: Multiple facilitators and barriers were identified that may affect the implementation of a blunt chest injury care bundle. Implementation strategies developed through this process have been included in a plan for implementation in the emergency departments of two hospitals. Evaluation of the implementation is underway.

Winged Ribs: An Underestimated Problem That May Compromise Breast Augmentation Outcomes.

Chest wall shape is an important aspect to consider when planning a breast augmentation. Minor chest wall deformities are usually underestimated by the patient and surgeon and may compromise postoperative outcomes. Lower costal cartilage dysmorphia or winged rib is one of these minor underestimated chest wall deformities characterized by a visible and palpable cartilaginous prominence under the inframammary fold and causes discomfort in patients decreasing the satisfaction with the breast augmentation surgery. For these patients, the author utilized an innovative surgical technique that allows resection of the protruding cartilages and placement of breast implants through the same surgical incision. Six patients with winged ribs underwent breast augmentation and costal cartilage resection via this method and there were no intraoperative or early postoperative complications, and all patients were satisfied with the aesthetical result after 6 months of follow-up. The presented surgical technique has a short learning curve with excellent postoperative results. Cases are presented to demonstrate the improved postoperative chest wall contour combined with breast augmentation outcome.Level of Evidence IV This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

Reconstruction of extensive thoracic wall defect using the external oblique myocutaneous flap: An analysis on 20 Chinese patients with locally advanced soft tissue sarcoma.

BACKGROUND: Soft tissue sarcomas are rare neoplasms that can occur in the thoracic wall, abdominal wall, extremities, and inguinal region. Wide local resection, with precise histological margin control, results in large skin defects that are challenging to close. Various repair procedures, such as vertical rectus abdominis flaps (VRAM), latissimus dorsi flaps, and tensor fascia lata (TFL) flaps are used to cover broad thoracic wall defects. Although the cosmetic reconstruction results of using these flaps are often excellent, each has significant drawbacks. The external oblique musculocutaneous flap is a simple and safe surgical procedure for covering thoracic wall defects. OBJECTIVE: This study aimed to retrospectively assess the safety and technique of using the external oblique musculocutaneous flap to cover large thoracic wall defects after radical excision of locally advanced sarcomas in 20 patients at a single institution. METHOD: From January 2006 to December 2016, 20 Chinese patients with large advanced sarcomas on their trunks received wide local resection, with precise histological negative margins. The external oblique musculocutaneous flap, mobilized from the ipsilateral abdominal wall, was harvested to cover broad thoracic wall defects. RESULTS: Among the 20 sarcoma patients (12 females and 8 males, ranging in age from 25 to 73 years), there were five patients with primary tumors and 15 patients with recurrent tumors. The median tumor diameter was approximately 15.3 cm. After excising the lesion, the median time to cover the defect with the external oblique myocutaneous flap was 66 min. The average blood loss when harvesting the flap was approximately 48 mL. For the 20 patients in our cohort, the external oblique flap achieved closure of defects measuring an average area of 256 cm2 . No other flaps or reconstruction techniques were used to cover the large defects in this study. There were no deaths directly related to the flap reconstruction procedures. CONCLUSION: The external oblique musculocutaneous flap was a safe and reliable method of covering broad thoracic wall defects after radical tumor excision.

Anaesthesia for chest wall reconstruction in a patient with Poland syndrome: CARE-compliant case report and literature review.

BACKGROUND: Poland syndrome is a rare congenital disease, characterized by agenesis/hypoplasia of the pectoralis major muscle, usually associated with variable thoracic anomalies that needed chest wall reconstruction under general anesthesia. Anaesthetic management in Poland syndrome has scarcely been described. CASE PRESENTATION: Here, we present our anaesthetic management of Nuss procedure for chest wall correction in a 5 years old patient with Poland syndrome. We also reviewed the reports of anaesthetic management of Poland syndrome by searching Pubmed, and summarize the perioperative procedures that may warrant a safe surgery. CONCLUSIONS: Examinations before surgery, intraoperative monitoring, choice of general anesthetics and pain management after surgery should all be contemplated.