Update Course Rewind: Chest Wall Reconstruction 2024

In this session from the 12th Annual Update Course in Pediatric Surgery, Dr. Margaret Mutch from Australia walks through the complexities of chest wall reconstruction following thoracic osteosarcoma resection in a pediatric patient.

Key Highlights:

• Massive resection and reconstruction: A 14-year-old patient underwent an aggressive en bloc resection involving ribs 4–7 and vertebral bodies T4–T7. The team used a combination of resorbable molded plates, Permacol mesh, and Gore-Tex patches to stabilize and recreate the chest wall structure.

• Soft tissue closure with latissimus flap: A latissimus dorsi flap was mobilized for robust coverage, reducing dead space and supporting tissue healing over the reconstructed area.

• Use of ROLL technique for lymph node excision: The team employed radio-guided occult lesion localization (ROLL) using Technetium-99 to precisely identify and remove targeted lymph nodes.

• Managing early complications: Postoperative challenges included sterile seromas, a wound infection, and mild scoliosis—all managed conservatively with good outcomes.

• Addressing recurrence and reoperation: When local recurrence occurred 18 months later, a second reconstruction involving the sternum and cement mesh was required, illustrating the long-term complexity of these cases.

• Future outlook for pediatric reconstructions: Dr. Mutch emphasized the lack of standardization in pediatric materials and techniques, pointing toward a future where custom 3D-printed implants and biologics may offer better long-term solutions.

This session highlights the surgical precision, interdisciplinary coordination, and resilience required to manage large-scale reconstructions in growing children—where both oncologic control and functional outcomes must be balanced.