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Many chest wall reconstruction algorithms have been proposed, but there is still no general consensus. The purpose of this study is to review our single institutional experience in chest wall reconstruction and identify a working algorithm based on our retrospective analysis. This is a retrospective analysis of 54 patients who underwent chest wall reconstruction in our department from 1996 to 2011. The mean follow-up was 38 months. Central chest wall defects were the most common, while infection and tumour resection were the two most common indications. The pedicled latissimus dorsi flap was a versatile flap, used as a single or combination flap for anterolateral, lateral and posterior defects. The pectoralis major flap was suitable for central and anterolateral defects and the rectus abdominis flap for lower central defects. Omentum flaps were useful in radiation-damage skin or in patients with recurrent infection. Locoregional flaps are the mainstay of chest wall reconstruction. Most skeletal reconstruction, when required, is safely accomplished with the use of prosthetic materials. Free flaps are usually only indicated for large defects or when regional flaps are unavailable. Level of Evidence: Level IV, therapeutic study.

Freon is an industrial refrigerant that can result in serious cryoinjury of the skin. Although there had been a few reported cases, the optimal management is not clear. We present the first case report of a patient with freon-induced cryoinjury of bilateral hands, complicated with compartment syndrome and treated with a combination of surgical decompression, negative-pressure wound therapy (NPWT), and hyperbaric oxygen therapy (HBOT). On follow-up, there was a complete healing without tissue loss or significant atrophy of the intrinsic muscles of the hand. Therefore, we opined that HBOT and NPWT may work synergistically to prevent progressive tissue damage and improve the long-term outcome, especially when vascularity is compromised in severe cryoinjuries of the hand. Level of Evidence: Level V, therapeutic study.