The Institute of Chest Wall Surgery
Wang Procedure for A 12-year-old Patient with Severe Poland Syndrome
Medical History
The patient, a 12-year-old boy, was diagnosed with Poland syndrome early in his childhood. Initially, as the deformity was mild, he did not receive any surgical treatment. However, the deformity began to worsen progressively from the age of 9, resulting in a pronounced depression on his right chest wall.
Preoperative Examination
The chest wall exhibits asymmetry, with a concavity on the right side and an absence of the pectoralis major. Additionally, multiple costal cartilages are hypoplastic, leading to the formation of local defects. The patient was diagnosed with severe Poland syndrome.
Surgical Overview
MatrixRIBs were first used to reconstruct the deficient costal cartilage in the right chest wall. Subsequently, the Wang procedure was performed to correct the depression. The operation proceeded smoothly and achieved satisfactory results, with the chest wall appearance essentially restored to normal after the surgery.
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The Key to Treating Poland Syndrome Lies in Correcting Bone Structure Rather Than Augmenting Soft Tissue
Poland syndrome is a rare condition that primarily affects one side of the chest wall and the corresponding upper limb. It mainly manifested as abnormalities in the appearance of the chest wall, including missing chest wall soft tissues, absent ribs and costal cartilages, and localized depressions. Additionally, the condition can include other abnormalities such as webbed fingers and spinal deformities.
Correcting bone structure of the chest wall is vital in treating Poland syndrome. By reconstructing the defective bone structure, it not only helps to improve the shape and function of the chest, but also enables the chest to obtain better support and stability, thereby reducing the risk of subsequent complications such as spinal deformities caused by asymmetry of the thoracic cage. Moreover, patients with this syndrome often suffer from respiratory issues due to the chest wall defects. Correcting bone structure allows the chest wall to restore its normal shape, thus alleviating pressure on the heart and lungs and significantly enhancing cardiopulmonary function.
In contrast, while soft tissue augmentation can improve the chest wall appearance, it fails to address the underlying structural and functional defects. Consequently, this approach typically offers only temporary improvements and may pose potential risks.
However, after the chest wall deformities are corrected, patients may choose soft tissue augmentation, such as breast augmentation for female patients after puberty, to achieve more ideal cosmetic results.