Using Local Flaps in a Chest Wall Reconstruction after Mastectomy for Locally Advanced Breast Cancer

Abstract

BackgroundSurgical ablation for locally advanced breast cancer results in large chest wall defects, which can then be managed with local flaps or skin grafts. The purpose of this article is to evaluate the outcomes of three types of local skin flaps.MethodsAmong 25 local flaps in 24 patients, 6 were bilateral advancement (BA) flaps, 9 were thoracoabdominal (TA) flaps, and 10 were thoracoepigastric (TE) flaps. Clinical outcomes were compared including complications, the need for a secondary surgical intervention, and the timing of adjuvant therapy.ResultsThe mean defect size was 436.2 cm2. Two patients with TA flaps and 6 patients with TE flaps developed distal flap necrosis, and skin grafts were needed to treat 2 patients with TE flaps. Radiation was administered to the BA, TA, and TE patients after average postoperative durations of 28, 30, or 41 days, respectively. The incidence of flap necrosis tended to be higher in TE patients, which lead to significant delays in adjuvant radiation therapy (P=0.02).ConclusionsThree types of local skin flaps can be used to treat large chest wall defects after the excision of locally advanced breast cancer. Each flap has its own merits and demerits, and selecting flaps should be based on strict indications based on the dimensions and locations of the defects.

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

“…Figure illustrates the dermofat flaps and fasciocutaneous flaps observed in the literature, with the main findings described in Table . Table summarizes the results of the flaps, providing data to evaluate the possibility of an association between flap type and the presence of necrosis.…”

“…Patchwork TAFs are usually created randomly, without the use of a specific pedicle. Descriptions of dermofat flaps and fasciocutaneous flaps are available. The IDATE flap is a dermofat flap in which irrigation is based on the posterior intercostal, subcostal, and lumbar arteries, given that it is a random lateral flap.…”

“…In LABC, chemotherapy and radiotherapy can be used as neoadjuvants aimed at decreasing tumor size and increasing resectability . However, because of local extension, it is often necessary to combine flaps with mastectomy aimed at primary closing, which can be accomplished with myocutaneous, fasciocutaneous, or dermofat flaps aimed at rapid healing and an early start for adjuvant therapy …”

Surgical Management of Breast Lesions at Tertiary Care Centre: An Institutional Experience of 100 Cases

“…Thoracoabdominal flaps were applied in eight cases of locally advanced cases of carcinoma breast with involvement of skin as fungating growth or ulcer. [23,24,25] Amongst that three showed flap necrosis and needed revision. Main cause of necrosis was infection due to co morbid condition like diabetes mellitus.…”

Chest wall reconstruction using Latismus Dorsi Flap: our experience

“…1,2 Generally, flaps are advantageous over the skin grafts in terms of aesthetics and durability especially when adjuvant radiotherapy is indicated. [2][3][4][5] The technique of using Latissmus Dorsi myocutaneous flap (LDMF) for closure of defects in oncologic breast surgery was first described by Tansini. 6 In the present study LDMF was used for covering chest wall defects in fifteen patients over a period of two years.…”