Abstract
Full-thickness defects of the chest wall are managed based on the principle of restoring structure and function. Characteristics of the lesion, such as size, location and etiology, as well as its resultant effects on pulmonary mechanics govern the surgical approach to reconstruction. Defects of intermediate size, however, occupy a gray area in thoracic wall reconstruction, with no clear consensus on management. The authors describe a novel method of providing bony coverage for a moderate-size thoracic wall defect in a patient with a complex intrathoracic, extrapleural hernia by crossing osteotomies in addition to transposition and fixation of ribs. Osseous rib Z-plasty is a novel surgical technique that may be considered to be a valid alternative for reconstruction of selected moderate-size, full-thickness defects of the lateral rib cage. Knowledge of this technique is recommended for thoracic, trauma and plastic surgeons who are likely to encounter and manage such defects.