Chest
Postoperative problems affecting the chest:
- The main reason for postoperative problems with the
‘chest’ are twofold.
- The chest, if seen as the lungs refers to chest infections, atelectasis (partial or complete collapse of the lung), pneumonia are all part of the potential generic postoperative problem scenario.
- The chest, if seen as maxillofacial specific refers to the chest wall, which is primarily the donor site for flaps in reconstructive maxillofacial surgery.
- Pectoralis major is the main, thick superficial chest muscle. For purposes of maxillofacial reconstructive surgery, this area is common to harvest chest wall pedicled (where the transferred tissue remains partially connected to the donor site) flaps where the skin and muscle of the chest wall, based on the acromiothoracic blood vessels (some small branches of veins and arteries under the pectoralis major muscle), are rotated to the head and neck. The donor site is usually closed primarily, rarely gets infected and heals well. The nipple is often moved to the midline. Haematoma (accumulation of clotted blood in tissue) can occur underneath the remaining skin of the chest wall even though drains are always placed. The chest feels tight and this can lead to chest infections. The scars can stretch and be unsightly and the female breast can be distorted. Some weakness in adduction (moving the arm inwards) of the arm will be noticed.
- The pectoralis minor muscle is a small triangular muscle covered by the pectoralis major muscle. It serves as donor site for free flaps used in facial reanimation surgery. The donor site defects are minimal and the scar is on the side of the chest and doesn’t spread.