Thoracic Wall Reconstruction

Abstract

Introduction The reconstruction of defects in thoracic wall remains a challenge for plastic surgeons. Advances in surgical treatment of illnesses of thoracic wall have been fostering the treatment of lesions within more advanced levels. Consequently, larger and more complex defects are generated, demanding soft tissue covering and framework repair. Objective The aim of this study was to report the experience in chest wall reconstruction and demographics of a tertiary cancer center. Methods All patients submitted to thoracic wall reconstruction by the plastic surgery department from January 2012 to May 2018 in a tertiary cancer center were evaluated. Results Thirty-two patients have undergone thoracic wall reconstruction. The majority of patients in our series were submitted to surgical treatment of locally advanced breast cancer (84.3%). The most common defect location was the right anterolateral region (65.6%). The latissimus dorsi musculocutaneous flap was the most used in thoracic wall reconstructions. Three cases of thoracectomy with rib resection were reconstructed with methylmethacrylate and polypropylene surgical mesh associated with musculocutaneous flap. Four patients presented major complications, and 12 patients (37.5%) presented minor complications. There were no deaths related to procedures or instability of thoracic wall. Twenty-two patients presented progression of the disease, and 16 died due to the primary pathology. Conclusions Extended resection of the chest wall is associated in most cases with advanced disease, especially advanced breast cancer. Despite poor prognosis associated to locally advanced disease, it is imperative to perform chest wall reconstruction and allow the patient to continue adjuvant therapy (radiotherapy or chemotherapy) and improve quality of life.

Postoperative Complications of Flap Procedures in Chest Wall Defect Reconstruction: A Two-Center Experience

“…In 35 procedures on 30 patients, a total of 35 complications occurred, resulting in a relative overall complication rate of 100% (37% major and 63% minor). Contrasting this and having used mainly pedicled latissimus dorsi flaps, Groth et al reported an overall complication rate of 50% (12.5% major and 37.5% minor complications) in a more than decade younger collective of 32 patients with mainly oncologic reconstructions [15]. In their definition of major complications, compared to our results, only complications requiring surgical procedures were considered.…”

“…While the first approach to chest wall reconstruction with a pedicled latissimus dorsi flap was delineated by Purpura in 1908, the reconstructive surgeon's toolbox has since evolved notably [14]. Despite a considerably high morbidity and mortality attributable to these complex operations, reconstruction has been shown to have a reasonable long-term survival while being safe and effective [9,15]. Many authors have put forth and adapted treatment algorithms for chest wall defects [5,12,16].…”

“…Many authors have put forth and adapted treatment algorithms for chest wall defects [5,12,16]. Apart from well-established pedicled flaps, microvascular free flap surgery has gained relevance and, despite higher complexity, longer operative time, and associated donor site morbidity, may be superior to regional myocutaneous flap reconstruction in selected circumstances such as following radiotherapy for extensive defects or when local options have been exhausted [9,11,12,15,17].…”

“…Contradicting common beliefs, it is clearly depicted by our results that free flap surgery, if performed by trained surgeons, is potentially safer than opting for local flap options at any cost. Nevertheless, it should be noted in this context that the pedicle-based latissimus dorsi flap is still a reliable reconstructive method in the absence of additional complicating factors and should be considered the workhorse for larger full-thickness thoracic defects [15,19].…”

Application of Three Different Types of Pedicled Latissimus Dorsi Flaps in Repairing Nearby Deep Soft Tissue Defects: Cosmetic Result and Shoulder Functionality Evaluation in One Center

“… 9 For these defects, musculocutaneous flaps perfused by large vessels, can increase the blood supply to the defects, fill the cavity, and cover the wounds. 10 Among these, the LD flap has been greatly applied.…”