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Introduction. Lung herniation following blunt force is a very rare occurrence of thoracic trauma with very few reported cases in medical literature. It can be defined as a protrusion of the pleural-covered parenchyma of the lung through an abnormal defect or chest wall weakness. It can also appear following thoracic surgery and can be classified based on location as parasternal, intercostal and supraclavicular. Case Presentation. A 60-year-old male was admitted to our hospital by emergency services following blunt thoracic trauma to head, chest, abdomen and lower and upper extremities. Upon admission, chest Computed Tomography was performed that showed a small herniation of left lung through 4th intercostal space and close to left parasternal line. He underwent surgical intervention for closure of lung hernia by mini-access thoracoplasty. There were no signs of recurrence after one month and three months of follow-up. Conclusions. Being a rare pathology, lung herniation is often overlooked in initial patient assessment, especially in a polytrauma patient where many clinical signs can often overlay one another. There is still no consensus regarding the surgical treatment of a pulmonary hernia. This can be done directly (primary) or delayed (secondary) and depends on the clinical condition of the patient.

Sternal cleft is a rare congenital abnormality that results from incomplete fusion of the two lateral mesodermal sternal bars. It is generally accepted that primary repair in the neonatal period is the best treatment option. However, significant distance between the sternal bars can be challenging because of cardiac compression. The aim. We report a case of a 7-day-old neonate with a subtotal sternal cleft successfully managed by direct closure. Material and methods. A full-term male neonate weighing 3 kg was referred to our clinic for evaluation of a chest wall defect. The chest X-ray and computed tomography were performed to evaluate the malformation. Results. Surgery was performed at the age of 7 days. Postoperative period was uneventful. The patient was discharged on the postoperative day 21. The first postoperative checkup after 3 months showed satisfactory cosmetic results and normal respiratory movements. Conclusion. Despite the significant diastasis between sternal bars, primary direct closure of the sternal cleft can be safely performed in neonates.

The objective of the study was to assess the possibility of combined plasty of a chest wall defect in a patient with a massive chondrosarcoma of the chest wall.Material and methods. The restoration of frame-based structures of the chest wall with 4 titanium prosthesis, flap of the left broadest muscle of the back on the stem.Results. Functional indices: the function of external respiration is within normal limits; lung capacity – 96 %; Stange assay – 1 min. 26 sec.; Genci test – 28 sec.Conclusion. The possibility of long-term survival with a good quality of life in a patient with extensive resection of the left half of the chest wall with dimensions up to 420 cm2 is shown.

Chest wall resection is performed for a variety of diseases, for primary rib and soft tissue tumors, metastatic lesions, or locally invasive growth of lung and mediastinal tumors being the most common indications. Following the resection phase, it is essential to determine the method of chest wall reconstruction that will restore the structural function, preserve pulmonary biomechanics, reduce the likelihood of residual pleural space, pulmonary hernia, and protect intrathoracic organs. The main objective of this study is to investigate the outcomes of chest wall resection with reconstruction using Codubix material., Material and Methods: This retrospective multicenter study included 22 patients who underwent chest wall tumor resection with subsequent Codubix rib endoprosthesis reconstruction from 2019 to 2023. Four medical institutions participated in the study: P.A. Herzen Moscow Cancer Research Institute, Sverdlovsk Regional Oncology Hospital, Morozov Children's City Clinical Hospital and Kaluga Regional Oncology Hospital. Inclusion criteria were the presence of chest wall tumors, both primary and secondary, removal of more than 2 ribs, resection of the rib arch and the sternum., Results: The median age was 60 years (48-66), 11 (50%) patients were females and 11 (50%) males. Operations for chest wall sarcoma, metastatic lesions, and lung cancer were performed in 9 (40.9%), 4 (18.2%), and 3 (13.6%) patients, respectively. The median number of removed ribs was 3 (2-4), with a maximum of 7. Sternotomy was performed in 9 (40.9%) patients, and subtotal resection of the body or handle of the sternum was carried out in 77.7%. Combined resections were performed in 14 (63.6%) patients. Radical tumor removal (R0) was achieved in 21 (95.5%) patients. Complications were observed in 9 (40.9%) patients, with intermuscular seroma being the most common in three (33.3%), followed by hydrothorax in 2 (22.2%), bilateral pneumonia, acute respiratory failure, and postoperative delirium in 1 (11.1%) patient each. One patient had the Codubix plate removed due to postoperative wound infection. The median overall and recurrence-free survival was not reached, and the 1-year recurrence-free survival was 63.9%, with an overall survival of 86.8%., Conclusion: Reconstruction with Codubix material allows for satisfactory functional and cosmetic results, characterized by a low complication rate and good adaptive properties.

The efficacy of the chest wall reconstruction with TiNi implants was assessed. Between 2007 and 2014, 21 patients with malignant tumors of the skin, soft tissues, ribs and sternum (sarcomas and metastases) underwent replacement of post-resection chest wall defects using the original Ti-Ni constructions. A total of 28 surgeries were performed including 19 single-stage reconstructions or 2 delayed reconstructions. The average square of the defect was 127 cm2 (40 to 323 cm2). results. Spontaneous breathing was restored on the day of surgery in 27 (96.4 %) cases. Chest carcass recovery was achieved in all cases. The amplitude reduction was observed in 10 (36 %) cases and complete elimination of pathological chest wall flotation was achieved in 18 (64 %) cases. Complications requiring surgery were observed in 3 (11 %) patients. At a long-term follow-up, 10 patients are alive. conclusion. The technique combining the use of TiNi alloy structures and complex autotissue grafts with axial type of blood supply allows chest wall cancer with extensive local spread to be successfully treated.

Today, in our country, as well as throughout the world, there is no single approach to the tactics of managing patients with deformations of the anterior chest wall. These patients constitute a large and heterogeneous group. The team acquired great experience in treating children with pectus excavatum and pectus carinatum, as well as a unique experience in the surgical treatment of pediatric thoracic outlet syndrome and sternum clefts. Now in the world there are a lot of surgical methods used for the correction of congenital deformities of the chest wall, however, the majority of them are extremely traumatic for the patient, and the postoperative scar often presents a minor cosmetic problem than the deformation itself. In addition, almost all methods require the use of expensive technologies, the patient's long hospital stay and the use of potent drugs. As for the children with thoracic outlet syndrome and sternum clefts, these patients are extremely difficult in terms of timely diagnosis and surgical care, due to the fact that pediatric surgeons and pediatricians are very little aware of this pathology. The team of authors developed a number of techniques, based on the collaborative work of surgeons, anesthesiology and resuscitation specialists and pediatric services. They resulted in successful surgical correction of these malformations and gave patients the opportunity to lead a normal life.