Analysis of the Chest Wall Reconstruction Methods after Malignant Tumor Resection

Abstract

Background The chest wall defects can be caused by various reasons. In the case of malignant tumor resection of the chest wall, it is essential to reconstruct the chest wall to cover the vital tissue and restore the pulmonary function with prevention of paradoxical motion. With our experience, we analyzed and evaluated the results and complications of the chest wall reconstructions followed by malignant tumor resection. Methods From 2013 to 2022, we reviewed a medical record of patients who received chest reconstruction due to chest wall malignant tumor resection. The following data were retrieved: patients' demographic data, tumor type, type of operation, method of chest wall reconstruction of the soft and skeletal tissue and complications. Results There were seven males and six female patients. The causes of reconstruction were 12 primary tumors and one metastatic carcinoma. The pathological types were seven sarcomas, three invasive breast carcinoma, and three squamous cell carcinomas. The skeletal reconstruction was performed in six patients. The series of the flap were eight pedicled latissimus dorsi (LD) myocutaneous flaps, two pectoralis major myocutaneous flap, two vertical rectus abdominis myocutaneous free flap, and one LD free flap. Among all the cases, only one staged reconstruction and successful reconstruction without flail chest. Most of the complications were atelectasis. Conclusion In the case of accompanying multiple ribs and sternal defect, skeletal reconstruction would need skeletal reconstruction to prevent paradoxical chest wall motion. The flap for soft tissue defect be selected according to defect size and location of chest wall. With our experience, we recommend the reconstruction algorithm for chest wall defect due to malignant tumor resection.

Anterolateral Thigh Chimeric Flap: An Alternative Reconstructive Option to Free Flaps for Large Soft Tissue Defects

“…Traditionally, various free flaps, such as the LD, TRAM, and ALT, have been used for the reconstruction of extensive large defects [9,[22][23][24][25][26]. Among these flaps, the ALT free flap is well known and has been used as a standard flap due to its advantages, such as the easy anatomical approach to pedicles and relatively easy harvesting [6,7,23]. However, when the defect is very large, the ALT flap alone may not be able to cover the defect.…”

“…Conventional reconstructive methods often rely on the use of free flaps, such as the latissimus dorsi (LD) flap and transverse rectus abdominis muscle (TRAM) flap, which have served as foundational techniques for addressing large soft tissue defects [4][5][6][7][8]. The LD flap, a reliable option, provides substantial tissue coverage but is associated with postoperative seroma formation and potential functional limitations in the arm [6].…”

Reconstruction of Chest Wall Defects in Resource-Constrained Settings

“…[4][5][6] The algorithm used by Sharma et al to chest wall reconstruction largely mirrors approaches that have been described by other authors. [6][7][8][9] Importantly, this algorithm may be generalizable to a range of healthcare settings, including those in low-or middle-income countries and other settings where resources are constrained. The vasculature and design of myocutaneous flaps based on pectoralis major, rectus abdominis, and latissimus dorsi muscles are well-described and can be performed by most reconstructive surgeons with minimal difficulty.…”