The ?epaulette? flap: replantation of osteomyocutaneous forearm segments in interscapulothoracic amputations

Total forearm free flap procedures after forequarter amputations have been sparsely described in the literature. Using the amputated arm as a "free filet flap" remains a viable surgical option after radical forequarter amputations performed for the resection of large, invasive tumors of the shoulder or thoracic wall region. Using the forequarter specimen as a donor site seems favorable in that it eliminates the usual donor site morbidity. Nevertheless, in our patient with invasive ductal carcinoma of the breast and a fibrosarcoma suffering from severe pain and septic conditions - which failed to respond properly to conservative therapy - as well as rapidly progressive tumor ulceration despite repeated radiation therapy, we decided to attempt complete tumor removal by hemithoracectomy as a last resort. This decision was taken following multiple interdisciplinary consultations and thorough patient information. Although technically feasible with complete tumor removal and safe soft tissue free flap coverage, the postoperative course raises questions about the advisability of such ultra radical surgical procedures, as well as about the limitations of respiratory recovery after hemithoracectomy with removal of the sternum. Hence, based on our experience with such radical tumor surgery, we discuss the issues of diminished postoperative pulmonary function, intensive care possibilities and ethical issues. The English full-text version of this article is available at SpringerLink (under "Supplemental").

Section: Diskussionunclassified

„Forequarter-Amputation“ des rechten oberen Rumpfs

Dragu

Hohenberger

Lang

et al. 2011

“…Hier sollte die Mög-lichkeit einer Schulterexartikulation oder interskapulothorakalen Amputation erwogen werden [38]. Obwohl sich hier der freie Transfer des kontralateralen Latissimus oder des Rectus abdominis eignen würden, macht es keinen Sinn, einen zusätzlichen Muskel von einer anderen Körperstelle zu opfern [10].…”

Section: Lappenkombinationen Und Mikrovaskuläre Technikenunclassified

“…Obwohl sich hier der freie Transfer des kontralateralen Latissimus oder des Rectus abdominis eignen würden, macht es keinen Sinn, einen zusätzlichen Muskel von einer anderen Körperstelle zu opfern [10]. Deshalb eigenen sich hier hervorragend, sofern onkologisch sicher, die Aufarbeitung des streckseitigen Oberarms als Filetlappen [10,38]. Im Fall einer interskapulothorakalen Amputation wird gelegentlich bei exulzerierenden Rezidivtumoren die Defektdeckung durch Oberarmfilets unmög-lich.…”

Section: Lappenkombinationen Und Mikrovaskuläre Technikenunclassified

Plastisch-chirurgische Rekonstruktion von Defekten der Thoraxwand nach onkologischen Resektionen

Riedel

Kremer

Hoffmann

et al. 2007

Self Cite

In defect reconstruction following radical oncologic resection of malignant chest wall tumors, adequate soft-tissue reconstruction must be achieved along with function, stability, integrity, and aesthetics of the chest wall. The purpose of this retrospective analysis was to evaluate the oncoplastic concept following radical resection of malignant chest wall infiltration with an interdisciplinary approach. Between 1999 and 2005, 36 consecutive patients (nine males, 27 females, mean age 55 years, range 20-78) were treated with resection for malignant tumors of the chest wall. Indications were locally recurrent breast carcinoma (patient n=22), thymoma (n=1), and desmoid tumor (n=1). Primary lesions of the chest wall were spinalioma (n=1), sarcoma (n=7), and non-small-cell lung cancer (n=2). There were distant metastases of colon and cervical cancer in one patient each. Soft-tissue reconstruction was carried out using primary closure (n=1), external oblique flap (n=1), pectoralis major myocutaneous flap (n=3), latissimus dorsi myocutaneous flap (n=18), vertical or transversal rectus abdominis myocutaneous flap (n=9), free tensor fascia lata- flap (n=6), trapezius flap (n=1), serratus flap (n=1), and one filet flap. In 15 reconstructive procedures microvascular techniques were used. An average of 3.4 ribs were resected. Stability of the chest wall was obtained with synthetic meshes. The latissimus dorsi flap is considered the flap of choice in chest wall reconstruction. However, alternatives such as pectoralis major flap, VRAM/TRAM flap, free TFL flap, and serratus flap must also be considered. Low mortality and morbidity rates allow tumor resection and chest wall reconstruction even in a palliative setting.

“…Thoracic wall tumors · Interscapulothoracic amputation · Indication · Technique · Interdisciplinary management ner erforderlichen R0-Resektion gedacht werden, da diese die prothetische Versorgung vereinfacht [6]. Dies war aber wegen der Tumorausbreitung in unseren Fäl-len nicht zu erzielen.…”

Section: Introductionunclassified

“…Plastische Deckungen bei nicht ausreichend deckungsfä-higem Hautmaterial sind z. B. durch lokale Schwenklappen, mit gestieltem Omentum majus, Radialislappentransfer vom amputierten Arm oder auch dem Epaulettelappen [6] möglich. Obgleich es sich um eine mutilierende Operation handelt, ist die onkologische Radikalität mit einer befriedigenden kosmetischen Versorgung durch Armprothesen vereinbar [4,5,8].…”

Section: Introductionunclassified

Interskapulothorakale Amputation nach Berger

Koscielny

Hirner²,

Kamiński³

2008

Interscapulothoracic amputation of the upper extremity, described for the first time by Berger in 1887, has undergone a change of indication. Originally performed in traumatic injuries of the shoulder or arm, it has been done in radical resection of malignancies of the upper extremity, axilla, or the surrounding thoracic wall. Particularly it is performed in tumors which cannot be controlled by neoadjuvant therapies or locally by radiation. The indication, technique, and results of such amputation are discussed by presenting our patients operated on with the procedure. Although this treatment is combined with a loss of function and body integrity, it is safe and sufficiently radical. The loss of function and integrity may be compensated by prosthetic reconstitution.