Poland’s syndrome revisited

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Presentation transcript:

Poland’s syndrome revisited Alexander A Fokin, MD, PhD, Francis Robicsek, MD, PhD The Annals of Thoracic Surgery Volume 74, Issue 6, Pages 2218-2225 (December 2002) DOI: 10.1016/S0003-4975(02)04161-9

Fig 1 Anatomic representation of classic Poland’s syndrome manifestations. The Annals of Thoracic Surgery 2002 74, 2218-2225DOI: (10.1016/S0003-4975(02)04161-9)

Fig 2 Photograph of a patient with Poland’s syndrome. The Annals of Thoracic Surgery 2002 74, 2218-2225DOI: (10.1016/S0003-4975(02)04161-9)

Fig 3 Chest involvement in moderate form of Poland’s syndrome. (A) Three-dimensional, oblique view showing chest wall depression with hypoplasia of ribs III to V. Mild rotation of the sternum. (B) Cross-sectional view showing normal position of the heart between the sternum and vertebral column. (C) Lateral view showing unilateral depression of the ribs. (D) Frontal view showing hypoplasia of the involved ribs. Normal position of the heart. The Annals of Thoracic Surgery 2002 74, 2218-2225DOI: (10.1016/S0003-4975(02)04161-9)

Fig 4 Chest involvement in severe form of Poland’s syndrome. (A) Three-dimensional, oblique view showing chest wall defect with aplasia of ribs III to V. Rotation of the sternum. (B) Cross-sectional view showing that the unprotected heart is shifted toward the unaffected side. (C) Lateral view showing unilateral depression of the ribs. (D) Frontal view showing aplasia of the involved ribs. Dextrocardia. The Annals of Thoracic Surgery 2002 74, 2218-2225DOI: (10.1016/S0003-4975(02)04161-9)

Fig 5 Surgical correction of a severe form of Poland’s syndrome with aplasia of ribs III to V and sternal rotation. (A) Split rib grafts are harvested from the contralateral side. (B) Grafts are sutured medially into previously created sternal notches, and laterally to the ends of the aplastic ribs. Sternal rotation is corrected by osteotomy and secured with a figure-eight suture. (C) Prosthetic mesh is sutured on top of the rib grafts and to the edges of the defect. The Annals of Thoracic Surgery 2002 74, 2218-2225DOI: (10.1016/S0003-4975(02)04161-9)

Fig 6 Surgical correction of Poland’s syndrome with aplasia of the anterior portion of two ribs. (A) Anatomic status and intended lines of incisions. (B) Unaffected ribs above and below the defect are split and attached to the stumps of the aplastic ribs. The Annals of Thoracic Surgery 2002 74, 2218-2225DOI: (10.1016/S0003-4975(02)04161-9)

Fig 7 Single stage reconstruction of the chest in adult patients with Poland’s syndrome. (A) Dorsal view of myocutaneous flap construction with preservation of the thoracodorsal neurovascular pedicle, transfer of the latissimus flap through an axillary tunnel, and suture of the anterior chest wall skin to the island (paddle) of the transplant. (B) Frontal view of myocutaneous flap construction with preservation of the thoracodorsal neurovascular pedicle, transfer of the latissimus flap through an axillary tunnel, and suture of the anterior chest wall skin to the island (paddle) of the transplant. (ART = artery;RECONSTR= reconstruction.) (Reprinted with permission from The Society of Thoracic Surgeons [Ann Thorac Surg 1984, 37, 204–11].) The Annals of Thoracic Surgery 2002 74, 2218-2225DOI: (10.1016/S0003-4975(02)04161-9)