Thoracic Wall Reconstruction after Tumor Resection

Abstract

IntroductionSurgical treatment of malignant thoracic wall tumors represents a formidable challenge. In particular, locally advanced tumors that have already infiltrated critical anatomic structures are associated with a high surgical morbidity and can result in full-thickness defects of the thoracic wall. Plastic surgery can reduce this surgical morbidity by reconstructing the thoracic wall through various tissue transfer techniques. Sufficient soft-tissue reconstruction of the thoracic wall improves quality of life and mitigates functional impairment after extensive resection. The aim of this article is to illustrate the various plastic surgery treatment options in the multimodal therapy of patients with malignant thoracic wall tumors.Materials and methodsThis article is based on a review of the current literature and the evaluation of a patient database.ResultsSeveral plastic surgical treatment options can be implemented in the curative and palliative therapy of patients with malignant solid tumors of the chest wall. Large soft-tissue defects after tumor resection can be covered by local, pedicled, or free flaps. In cases of large full-thickness defects, flaps can be combined with polypropylene mesh to improve chest wall stability and to maintain pulmonary function. The success of modern medicine has resulted in an increasing number of patients with prolonged survival suffering from locally advanced tumors that can be painful, malodorous, or prone to bleeding. Resection of these tumors followed by thoracic wall reconstruction with viable tissue can substantially enhance the quality of life of these patients.DiscussionIn curative treatment regimens, chest wall reconstruction enables complete resection of locally advanced tumors and subsequent adjuvant radiotherapy. In palliative disease treatment, plastic surgical techniques of thoracic wall reconstruction provide palliation of tumor-associated morbidity and can therefore improve patients’ quality of life.

Materials and techniques in chest wall reconstruction: a review

“…Other composite implant techniques, applying silicone tubes, rubber and Carbone fiber systems have been described in case reports (11,23,24,25). PTFE PTFE (GORE-TEX) is another material well-suited and commonly used for chest wall reconstruction.…”

“…However, we must consider that in trauma patients titanium plates are always the only material used for chest wall stabilization, while in neoplastic cases the reconstruction of the chest wall requires integration with traditional techniques, such as synthetic biologic or titanium meshes (Figures 7,8) and various muscle flaps. Many authors (1,(25)(26)(27)(28) agree that titanium system represents a better solution in the reconstruction of large full-thickness defects, restoring the rigidity of the thoracic cage and preventing respiratory and infective complications. Few complications, as plate fracture, bar dislocation and thoracic pain, are described for this system.…”

“…Nevertheless several case series reported on important functional results, without an high infection rate (4,5,16). Most of the authors agree that complete coverage with viable soft tissue in this chest wall reconstruction is an essential step to minimize the risk of local complications (4,5,16,23).Other composite implant techniques, applying silicone tubes, rubber and Carbone fiber systems have been described in case reports (11,23,24,25). PTFE PTFE (GORE-TEX) is another material well-suited and commonly used for chest wall reconstruction.…”

ITADE flap after mastectomy for locally advanced breast cancer: A good choice for mid‐sized defects of the chest wall, based on a systematic review of thoracoabdominal flaps

“…In reconstructive surgery of the thoracic wall, several techniques and variations have been described. There is no consensus on which technique should be used; the choice depends on the surgeon's experience, personal preference, or prior experience in performing local or myocutaneous flaps, the nature of the surgery, the morbidity related to the procedure and the size of the chest wall defect . Generally, healing or potentially curative surgeries are attempted, associated with free margins, with little morbidity, aimed at quick use of adjuvant therapy and local control.…”

Chest wall reconstruction using Latismus Dorsi Flap: our experience

“…Important factors for consideration are coverage with healthy tissue for early wound healing and to cover vital structures. 13,14 In contrast to the dramatic evolution in the field of breast reconstruction, less attention has been paid by surgeons at large regarding the reconstruction of the large chest wall defects following so called "toilet mastectomy", wherein the stress of the operating surgeon is towards the aim of ablating the breast and skin tissues and minimizing oncologic recurrence in locally advanced breast cancers. 15,16 Many flaps have been documented in literature with an eventual goal to provide early wound healing such as fasciocutaneous flaps, muscle flaps (Pedicled or Free).…”