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Kim J, Lee KT. Microsurgical reconstruction using thoracoacromial vessels as recipients for complicated chest wall defects. Microsurgery 2024; 44:e31164. [PMID: 38530144 DOI: 10.1002/micr.31164] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2023] [Revised: 01/09/2024] [Accepted: 02/15/2024] [Indexed: 03/27/2024]
Abstract
BACKGROUND Free tissue transfer is often required for the reconstruction of complex and deep anterior chest wall wounds, for which the identification of suitable recipient vessels is crucial. Although the internal mammary arteries (IMAs) are a representative option, identifying secondary options when these vessels are compromised remains a challenge. This report evaluated the efficacy of using the thoracoacromial vessels (TAVs) as recipients for chest wall reconstruction by reviewing our experience. METHODS We conducted a retrospective review of patients undergoing free-flap-based chest wall reconstruction using TAVs as recipient vessels from February 2020 to March 2023. Patient demographics and surgery-related characteristics data were collected. The primary outcome of interest was the occurrence of flap perfusion-related complications. RESULTS In total, 12 cases utilized TAVs as recipients, primarily for defects following sternotomy, where bilateral IMA was unavailable due to prior surgery. The TAVs with reliable perfusion were consistently identified beneath the pectoralis major muscle. The anterolateral thigh flap was predominantly employed, with musculocutaneous or chimeric flaps introduced for bony defects. The mean pedicle length of the harvested flap was 7.2 cm (range, 3-13), and in cases with a vascular gap, the pedicle was extended using an arteriovenous interposition graft. This resulted in a mean pedicle length needed to reach recipient vessels of 9.9 cm (range, 6.5-19). All flaps survived, with only one experiencing partial necrosis. CONCLUSIONS The TAV could be considered as an attractive alternative recipient vessel in microsurgical reconstruction of complicated chest wall defects when the use of IMA is not feasible.
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Affiliation(s)
- Jisu Kim
- Department of Plastic Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
| | - Kyeong-Tae Lee
- Department of Plastic Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
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2
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Colella S, Brandimarte A, Marra R, Marinari S, D’Incecco A, Di Genesio Pagliuca M, De Vico A, Crisci R, Divisi D. Chest wall reconstruction in benign and malignant tumors with non-rigid materials: An overview. Front Surg 2022; 9:976463. [PMID: 35990091 PMCID: PMC9381953 DOI: 10.3389/fsurg.2022.976463] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2022] [Accepted: 07/11/2022] [Indexed: 11/13/2022] Open
Abstract
Several materials and techniques have been described for the procedure of chest wall reconstruction: the choice of using a technique or a material over another relies mainly on the surgeon's experience as well as thoracic defect localization and dimension, local availability of materials, and costs. From a technical point of view, autologous and alloplastic reconstruction are available, and, in both cases, rigid and non-rigid prostheses are found. Each material has its peculiarities, with advantages and disadvantages; thus, it is mandatory to be confident when planning the intervention to foresee possible complications and minimize them. We have reviewed the literature on chest wall reconstruction in chest wall tumors (both malignant and non malignant) with non-rigid prosthetic materials, focusing on safety outcomes.
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Affiliation(s)
- Sara Colella
- Unit of Respiratory Diseases, “G. Mazzini” Hospital, Teramo, Italy
| | | | - Roberta Marra
- Unit of Respiratory Diseases, “V. Fazzi” Hospital, Lecce, Italy
| | - Stefano Marinari
- Unit of Respiratory Diseases, “G. Mazzini” Hospital, Teramo, Italy
| | - Armida D’Incecco
- Medical Oncology Unit, “Giuseppe Mazzini” Hospital, Teramo, Italy
| | | | - Andrea De Vico
- Department of Life, Health and Environmental Sciences, University of L’Aquila, Thoracic Surgery Unit, “Giuseppe Mazzini” Hospital, Teramo, Italy
| | - Roberto Crisci
- Department of Life, Health and Environmental Sciences, University of L’Aquila, Thoracic Surgery Unit, “Giuseppe Mazzini” Hospital, Teramo, Italy
| | - Duilio Divisi
- Department of Life, Health and Environmental Sciences, University of L’Aquila, Thoracic Surgery Unit, “Giuseppe Mazzini” Hospital, Teramo, Italy
- Correspondence: Duilio Divisi ;
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3
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Giordano S, Garvey PB, Clemens MW, Baumann DP, Selber JC, Rice DC, Butler CE. Synthetic Mesh Versus Acellular Dermal Matrix for Oncologic Chest Wall Reconstruction: A Comparative Analysis. Ann Surg Oncol 2020; 27:3009-3017. [PMID: 32152778 DOI: 10.1245/s10434-019-08168-z] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2019] [Indexed: 11/18/2022]
Abstract
BACKGROUND Management of chest wall defects after oncologic resection is challenging due to multifactorial etiologies. Traditionally, skeletal stabilization in chest wall reconstruction (CWR) was performed with synthetic prosthetic mesh. The authors hypothesized that CWR for oncologic resection defects with acellular dermal matrix (ADM) is associated with a lower incidence of complications than synthetic mesh. METHODS Consecutive patients who underwent CWR using synthetic mesh (SM) or ADM at a single center were reviewed. Only oncologic defects involving resection of at least one rib and reconstruction with both mesh and overlying soft tissue flaps were included in this study. Patients' demographics, treatment factors, and outcomes were prospectively documented. The primary outcome measure was surgical-site complications (SSCs). The secondary outcomes were specific wound-healing events, cardiopulmonary complications, reoperation, and mortality. RESULTS This study investigated 146 patients [95 (65.1%) with SM; 51 (34.9%) with ADM] who underwent resection and CWR of oncologic defects. The mean follow-up period was 29.3 months (range 6-109 months). The mean age was 51.5 years, and the mean size of the defect area was 173.8 cm2. The SM-CWR patients had a greater number of ribs resected (2.7 vs. 2.0 ribs; p = 0.006) but a similar incidence of sternal resections (29.5% vs. 23.5%; p = 0.591) compared with the ADM-CWR patients. The SM-CWR patients experienced significantly more SSCs (32.6% vs. 15.7%; p = 0.027) than the ADM-CWR patients. The two groups had similar rates of specific wound-healing complications. No differences in mortality or reoperations were observed. CONCLUSIONS The ADM-CWR patients experienced fewer SSCs than the SM-CWR patients. Surgeons should consider selectively using ADM for CWR, particularly in patients at higher risk for SSCs.
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Affiliation(s)
- Salvatore Giordano
- Department of Plastic Surgery, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Patrick B Garvey
- Department of Plastic Surgery, The University of Texas MD Anderson Cancer Center, Houston, TX, USA.
| | - Mark W Clemens
- Department of Plastic Surgery, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Donald P Baumann
- Department of Plastic Surgery, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Jesse C Selber
- Department of Plastic Surgery, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - David C Rice
- Department of Thoracic Surgery, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Charles E Butler
- Department of Plastic Surgery, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
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4
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Kuo CY, Lin SH, Lee KD, Cheng SJ, Chu JS, Tu SH. Transcatheter arterial chemoembolization improves the resectability of malignant breast phyllodes tumor with angiosarcoma component: a case report. BMC Surg 2019; 19:100. [PMID: 31351458 PMCID: PMC6660949 DOI: 10.1186/s12893-019-0562-0] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2019] [Accepted: 07/15/2019] [Indexed: 11/10/2022] Open
Abstract
Background A giant phyllodes tumor of the breast is a rare fibroepithelial lesion, and its treatment is controversial. Many case reports have reported performing skin graft reconstruction after tumor excision. Chest wall resection may be required if the tumor has invaded the chest muscle layer. We speculated that transcatheter arterial chemoembolization (TACE) can improve the resectability of malignant phyllodes tumor of the breast without requiring skin grafting. The English literature contains only one case report similar to our experience. Case presentation We report a rare case of a 51-year-old woman who had a giant malignant phyllodes tumor with heterologous sarcomatous differentiation in her right breast. The tumor was 19.43 × 12.98 × 21.47 cm. Whole-body computed tomography (CT) and bone scan did not reveal distant metastasis. Chest magnetic resonance imaging showed chest wall tumor invasion. Considering that skin defects after mastectomy can be extensive, we administered four courses of chemoembolization in the 5 weeks before surgery (30 mg of epirubicin and embozene microspheres [400, 500, and 700 μm]/week). Each process was well tolerated, with no serious complications. Only fever and local pain at the tumor site were noted, and these symptoms resolved with time. The follow-up CT scan showed a 45% reduction in tumor volume. Therefore, simple mastectomy was performed without skin grafting reconstruction. Wound healing was satisfactory, and the patient was discharged 1 week after surgery. Pathological and immunohistochemistry (IHC) findings showed a malignant phyllodes tumor with an angiosarcoma component. Because of tumor invasion of the chest wall, we recommended the patient receive radiotherapy, but she refused. Two months after surgery, recurrence of the malignant phyllodes tumor with right axillary lymph node involvement and lung metastasis was confirmed. Conclusion Initial surgical resection of giant phyllodes tumors is often challenging. For initial presentation with unresectable giant phyllodes tumor, we recommend to perform TACE prior to surgery. In our patient, preoperative TACE was effective and safe. If the tumor has invaded the chest wall, early radiotherapy after surgery may be recommended for preventing recurrence.
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Affiliation(s)
- Chih-Yu Kuo
- Department of Surgery, Taipei Medical University Hospital, Taipei, Taiwan
| | - Shing-Huey Lin
- Division of Family Medicine, Cathay General Hospital, Taipei, Taiwan
| | - Kuan-Der Lee
- Division of Hematology and Oncology, Department of Internal Medicine, Taipei Medical University Hospital, and School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan
| | - Sho-Jen Cheng
- Department of Medical Imaging, Taipei Medical University Hospital, Taipei, Taiwan
| | - Jan-Show Chu
- Department of Pathology, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan
| | - Shih-Hsin Tu
- Division of Breast Surgery, Department of Surgery, Taipei Medical University Hospital, Taipei, Taiwan. .,Department of Surgery, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan. .,Taipei Cancer Center, Taipei Medical University, Taipei, Taiwan.
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Sternectomy for Treating Advanced Non-Melanoma Skin Cancer. J Skin Cancer 2019; 2019:3948782. [PMID: 31275656 PMCID: PMC6582790 DOI: 10.1155/2019/3948782] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2019] [Revised: 04/13/2019] [Accepted: 04/23/2019] [Indexed: 11/17/2022] Open
Abstract
Introduction Skin cancer is a rare indication of sternectomy. Our goal is to report the clinical course of seven patients who underwent sternectomy for skin cancer. Methods The survey data were collected from medical records of patients treated between 2008 and 2018 at Ceará Cancer Institute. Results All patients had prolonged sunlight exposure and average disease time of two years and age of 60 years. Most patients recovered favorably after treatment with prolonged survival. Conclusion Sternectomy remains an option with curative purposes for locally advanced skin cancer.
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Chest Wall Resection for Recurrent Breast Cancer in the Modern Era: A Systematic Review and Meta-analysis. Ann Surg 2019; 267:646-655. [PMID: 28654540 DOI: 10.1097/sla.0000000000002310] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
Abstract
OBJECTIVE To review the literature on chest wall resection for recurrent breast cancer and evaluate overall survival (OS) and quality-of-life (QOL) outcomes. BACKGROUND Full-thickness chest wall resection for recurrent breast cancer is controversial, as historically these recurrences have been thought of as a harbinger of systemic disease. METHODS A systematic search in MEDLINE, EMBASE, and Cochrane CENTRAL identified 48 eligible studies, all retrospective, accounting for 1305 patients. The review is reported following Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Primary end points were patient-centered QOL outcomes and OS; secondary outcomes included disease-free survival (DFS) and 30-day morbidity. Risk of bias was assessed using the Methodological Index for Non-Randomized Studies instrument and the Oxford Centre for Evidence-Based Medicine's levels of evidence tool. Random-effects meta-analysis was used to create pooled estimates. Meta-regressions and sensitivity analyses were used to explore study heterogeneity by age, year of publication, risk of bias, and surgical intent (curative vs palliative). RESULTS Studies consistently reported excellent OS and DFS in properly selected patients. Pooled estimates for 5-year OS in all studies and those from the past 15 years were 40.8% [95% confidence interval (CI) 35.2-46.7) and 43.1% (95% CI 35.8-50.7), whereas pooled 5-year DFS was 27.1% (95% CI 16.6-41.0). Eight studies reported excellent outcomes related to QOL. Mortality was consistently low (<1%) and 30-day pooled morbidity was 20.2% (95% CI 15.3%-26.3%). Study quality varied, and risk of selection bias in included studies was high. CONCLUSIONS Full-thickness chest wall resection can be performed with excellent survival and low morbidity. Few studies report on QOL; prospective studies should focus on patient-centered outcomes in this population.
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Elkhouly AG, Cervelli V, Sanese G, Pompeo E. Hump-like giant desmoid tumor of the chest: a postresectional reconstruction challenge. AME Case Rep 2018; 1:6. [PMID: 30263993 DOI: 10.21037/acr.2017.11.01] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2017] [Accepted: 10/31/2017] [Indexed: 11/06/2022]
Abstract
Desmoid tumors (DT) are rare neoplasms with unknown etiology arising from musculoaponeurotic structures. Chest wall localization is uncommon and has been associated with high recurrence rate unless radical resection with negative margins is carried out. Postresectional reconstruction can be challenging in presence of giant lesions and might require adoption of complex reconstruction methods including use of well vascularized muscle flaps. We present a case of giant hump-like recurrent chest wall DT, which was radically resected following placement of multiple subcutaneous silicon tissue expanders, to gain redundant skin, which eventually allowed in conjunction with two transposition, cutaneous-adipose flaps, harvested from the upper gluteal region, an optimal reconstruction of the large postresectional defect.
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Affiliation(s)
- Ahmed G Elkhouly
- Department of Cardiothoracic Surgery, Faculty of Medicine, Tanta University, Tanta, Egypt
| | - Valerio Cervelli
- Department of Plastic and Reconstructive Surgery, Policlinico Tor Vergata University, Rome, Italy
| | - Giuseppe Sanese
- Department of Plastic and Reconstructive Surgery, Policlinico Tor Vergata University, Rome, Italy
| | - Eugenio Pompeo
- Department of Thoracic Surgery, Policlinico Tor Vergata University, Rome, Italy
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8
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Abdel Rahman ARM, Rahouma M, Gaafar R, Bahaa S, Loay I, Kamel M, Abdelbaki H, Yahia M. Contributing factors to the outcome of primary malignant chest wall tumors. J Thorac Dis 2018; 9:5184-5193. [PMID: 29312725 DOI: 10.21037/jtd.2017.11.61] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Background Primary malignant chest-wall tumors (PMCWTs) are a heterogeneous group of tumors. They require a special experience in designing resection and reconstruction. They account for less than 1% of all primary malignant tumors. This study is designed to clarify different factors contributing to the outcome of patients with PMCWTs in our institution. Methods A retrospective study included 98 patients with pathology proven PMCWTs, treated at the National Cancer Institute (NCI), Cairo University, Egypt, during the past 10 years. Used variables were: age, sex, forced expiratory volume in the 1st second (FEV1), site, size, multiplicity, pathologic subtype, tumor grade, safety margin (SM), excised ribs, complications, estimated blood loss (EBL), neo-adjuvant and adjuvant treatments, Overall and disease free survival (DFS) were obtained using Kaplan-Meier method and compared using Log rank test. Cox regression was used to identify DFS predictors. Results PMCWTs represented 10.5% of all thoracic malignancies in our institution. There were 51 females (52%). The median age was 39 years [interquartile range (IQR) =25-52.3)] years. Chondrosarcoma was the commonest tumor histology (20.4%). The median tumor size was 8 cm (IQR =5-14). Tumor multiplicity was found in 18.4% of patients. Bone resection was performed in 76 patients (78.3%), ribs resection was performed in 59 patients and the median number of resected ribs per patient was 3 (IQR =1-3) ribs. Sternal resection was done in 7 (7.1%) cases. R0 resection was achieved in 62.2% of patients. There was one operative related mortality (1.02%) and 17.3% patients suffered procedure related complications. Local recurrence developed in 35 (35.7%) patients. The overall survival (OS) at 1, 3 and 5 years was 73.9%, 45.6% and 34.6% respectively and the median OS was 33 months (95% CI, 21.8-44.2), while median DFS was 24 months (95% CI, 19.6-28.4). Predictors of better DFS were -ve SM (P<0.001), tumors <5 cm (P=0.039), low grade (P=0.033), lower EBL (P=0.003) and absence of adjuvant therapy (P=0.007); however, on multivariate analysis, only -ve SM was the only predictor (HR =0.54; 95% CI, 0.29-0.97, P=0.041). Conclusions In primary malignant CWTs (PMCWTs) achievement of wide resection margins is of great importance to minimize the local tumor recurrence that will have an adverse impact on long-term survival.
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Affiliation(s)
| | - Mohamed Rahouma
- Surgical Oncology Department, National Cancer Institute, Cairo University, Cairo, Egypt
| | - Rabab Gaafar
- Medical Oncology Department, National Cancer Institute, Cairo University, Cairo, Egypt
| | - Sherif Bahaa
- Surgical Oncology Department, National Cancer Institute, Cairo University, Cairo, Egypt
| | - Iman Loay
- Cancer Pathology Department, National Cancer Institute, Cairo University, Cairo, Egypt
| | - Mohamed Kamel
- Surgical Oncology Department, National Cancer Institute, Cairo University, Cairo, Egypt
| | - Hoda Abdelbaki
- Radiation Therapy Department, National Cancer Institute, Cairo University, Cairo, Egypt
| | - Maha Yahia
- Medical Oncology Department, National Cancer Institute, Cairo University, Cairo, Egypt
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D'Amico G, Manfredi R, Nita G, Poletti P, Milesi L, Livraghi L, Poletti E, Verga M, Robotti E, Ansaloni L. Reconstruction of the Thoracic Wall With Biologic Mesh After Resection for Chest Wall Tumors: A Presentation of a Case Series and Original Technique. Surg Innov 2017; 25:28-36. [PMID: 29251555 DOI: 10.1177/1553350617745954] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
Abstract
INTRODUCTION Synthetic materials have traditionally been used for tissue reconstruction in thoracic surgery. New biomaterials have been tested in other areas of surgery with good results. Non-cross-linked swine dermal collagen prosthesis has been used to reconstruct musculofascial defects in the trunk with low infection and herniation rate. MATERIAL AND METHODS Retrospectively, we analyze our initial experience of chest wall reconstruction on large defects using a non-cross-linked swine dermal collagen matrix mesh with a thickness of 1.4 mm. A total of 11 consecutive patients were included. Preoperative, intraoperative, and postoperative data were taken into consideration. RESULTS Eleven sarcoma patients with a mean age of 58.25 ± 12.9 years underwent chest wall resections. Complete thoracic wall defects ranged from 6 · 9 to 16 · 25 cm in size. In all cases, we used a porcine collagen matrix mesh, and in all patients, it was covered by transposition of myocutaneous flap. The complications occurred in 5 (45%) patients, 1 (9%) pneumonia, 1 atrial fibrillation (9%), and 3 (27%) wound healing difficulty because of hematoma or infection. There was no respiratory impairment, and the pulmonary function (total lung capacity, vital capacity, and forced expiratory volume in 1 second) was not statistically different before and after surgery. The 30-day mortality was 0%, 1-year mortality and 2-year mortality was 27.2%. The collagen material resulted in a durable and good to excellent chest wall stability in clinical follow-ups, and on computer tomography scans spanning over 2 years. CONCLUSION Non-cross-linked acellular porcine dermal collagen matrix is a feasible and reliable biological patch material for reconstruction of the thoracic wall. Excellent wound healing, long-term stability, low complication, and good pulmonary function are achieved even in large defects.
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Perforator Flaps Covering Alloplastic Materials in Full-Thickness Chest Wall Defects Reconstruction: A Safe Option? PLASTIC AND RECONSTRUCTIVE SURGERY-GLOBAL OPEN 2017; 5:e1289. [PMID: 28607844 PMCID: PMC5459627 DOI: 10.1097/gox.0000000000001289] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2016] [Accepted: 02/15/2017] [Indexed: 11/25/2022]
Abstract
Large full-thickness chest wall reconstruction requires an alloplastic material to ensure chest wall stability, as well as a flap that provides good soft-tissue coverage. The choice not to use perforator flaps over any mesh or inert material is often based on the concern that the vascularization would be inadequate. However, perforator flaps have shown good results in several reconstructive fields, minimizing donor-site morbidity and offering versatility when local tissues are unavailable or affected by radiotherapy. In this study, we present 4 cases of patients with full-thickness chest wall defects that were repaired with a double Marlex mesh, acrylic cement (n = 2) or a double patch of Goretex (n = 2) in combination with perforator flaps (3 deep inferior epigastric artery perforators and 1 lumbar artery perforator flap). The results we obtained are encouraging, and we believe the use of perforator flaps in combination with alloplastic materials should be considered as a reliable option for full-thickness chest wall defect reconstruction.
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Nagasao T, Kasai S, Shimizu Y, Sakamoto Y, Hatano A, Morotomi T, Ogata H, Kishi K. A biomechanical study of relationship between sternum defect patterns and thoracic respiration. Comput Assist Surg (Abingdon) 2016; 21:1-8. [PMID: 27973954 DOI: 10.3109/10929088.2015.1076038] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Various types of sternum defects are produced after the removal of thoracic tumors involving the sternum. The present study aims to elucidate the relationship between the defect patterns and their effects on thoracic respiration. METHODS Ten sets of finite element models were produced simulating thoraces of 10 persons and termed normal models. With each of the 10 normal models, the sternum was removed in six different ways to produce new models termed defect models. Defect models were categorized into hemi-superior (H-S), hemi-inferior (H-I), hemi-whole length (H-W), bilateral-superior (B-S), bilateral-inferior (B-I), and bilateral-whole length (B-W) defect types, depending on the locations of the defects. Respiratory movement was dynamically simulated with these models. The volume change the thoraces present during respiration was measured to evaluate the effectiveness of thoracic respiration. This value - defined as ΔV - was calculated and was compared between normal and defect models. RESULTS With H-W and B-W type models, ΔV dropped to around 20% of normal values. With H-S and B-S type models, ΔV dropped to around 50% of normal values. With H-I and B-I type models, ΔV presented values almost equivalent to those of normal models. CONCLUSION Effectiveness of thoracic respiration is seriously impaired when the whole length of the sternum is absent. Reconstruction of the defect is essential for these cases. However, since the upper part of the sternum is most important for effective thoracic respiration, priority should be placed on the upper part in performing reconstruction.
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Affiliation(s)
- Tomohisa Nagasao
- a Department of Plastic and Reconstructive Surgery , Keio University Hospital , Tokyo , Japan
| | - Shogo Kasai
- a Department of Plastic and Reconstructive Surgery , Keio University Hospital , Tokyo , Japan
| | - Yusuke Shimizu
- a Department of Plastic and Reconstructive Surgery , Keio University Hospital , Tokyo , Japan
| | - Yoshiaki Sakamoto
- a Department of Plastic and Reconstructive Surgery , Keio University Hospital , Tokyo , Japan
| | - Asako Hatano
- b Department of Plastic and Reconstructive Surgery , Kawasaki Municipal Hospital , Kawasaki , Japan
| | - Tadaaki Morotomi
- c Department of Plastic Surgery , Kinki University Hospital , Tokyo , Japan , and
| | - Hisao Ogata
- a Department of Plastic and Reconstructive Surgery , Keio University Hospital , Tokyo , Japan
| | - Kazuo Kishi
- a Department of Plastic and Reconstructive Surgery , Keio University Hospital , Tokyo , Japan.,d Department of Plastic Surgery , The Second Military Medical University, Chang Zheng Hospital , Shanghai , Japan
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12
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Kua EHJ, Chia HL, Goh TLH, Lim CH, Ng SW, Tan BK. A general algorithm for chest wall reconstruction based on a retrospective review. EUROPEAN JOURNAL OF PLASTIC SURGERY 2015. [DOI: 10.1007/s00238-015-1078-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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13
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Bodin F, Dissaux C, Steib JP, Massard G. Complex posterior thoracic wall reconstruction using a crossover combined latissimus dorsi and serratus anterior free flap. Eur J Cardiothorac Surg 2015; 49:1008-9. [PMID: 25825263 DOI: 10.1093/ejcts/ezv141] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/13/2015] [Accepted: 03/11/2015] [Indexed: 11/12/2022] Open
Abstract
Radical resection of an extended malignant sarcoma of the chest wall requires full-thickness thoracic chest wall reconstruction. Reconstruction is tedious in the case of posteriorly located tumours, because the ipsilateral pedicled myocutaneous latissimus dorsi flap is involved and hence not usable for soft tissue coverage. We report an original case of a left giant dorsal chondrosarcoma originating from the 11th costovertebral joint. After extended resection and skeletal reconstruction, soft tissue coverage was achieved with an original contralateral free flap encompassing both latissimus dorsi and serratus anterior muscles. The flap pedicle was anastomosed to the ipsilateral thoracodorsal vessels.
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Affiliation(s)
- Frédéric Bodin
- Department of Plastic Surgery, Strasbourg Academic Hospital, Strasbourg, France
| | - Caroline Dissaux
- Department of Plastic Surgery, Strasbourg Academic Hospital, Strasbourg, France
| | - Jean-Paul Steib
- Department of Spine Surgery, Strasbourg Academic Hospital, Strasbourg, France
| | - Gilbert Massard
- Department of Thoracic Surgery, Strasbourg Academic Hospital, Strasbourg, France
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14
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Pelzer M, Germann G, Czermak C, Reichenberger M. [Combined split ALT/TFL flap for soft tissue coverage in large thoracical defects]. Chirurg 2015; 85:42-5. [PMID: 23784535 DOI: 10.1007/s00104-013-2547-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
BACKGROUND Large, ulcerating tumors of the chestwall require soft tissue coverage after resection. Depending on size and location usually a latissimus dorsi flap, VRAM or TRAM flap is performed. In very large defects a combined split ALT/TFL flap is a new technique for coverage. PATIENT AND METHODS In 4 patients (3 female, 1 male) a soft tissue reconstruction after tumor resection was necessary. The mean age was 54 years. The mean size of the defect was 656 cm(2). RESULTS In 3 cases the coverage was achieved by a unilateral, and in 1 case a bilateral combined split ALT/TFL flap. All flaps healed without flap loss. The donor site closure was achieved primarily in 2 cases. In 3 cases a small split skin graft was needed. CONCLUSION The indications for combined split ALT/TFL flaps are large defects which cannot be covered by one single flap. The combination of these two long-known flaps on one pedicle is a new development.
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Affiliation(s)
- M Pelzer
- Ethianum Klinik Heidelberg, Vossstr. 6, 69115, Heidelberg, Deutschland,
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Claro F, Sarian LOZ, Pinto-Neto AM. Omentum for Mammary Disorders: A 30-Year Systematic Review. Ann Surg Oncol 2015; 22:2540-50. [PMID: 25572679 DOI: 10.1245/s10434-014-4328-8] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2014] [Indexed: 11/18/2022]
Abstract
PURPOSE Although the safety of applying omentum to the female breast for total breast reconstruction is controversial, it has recently been used to treat certain mammary disorders as well. A systematic review was therefore conducted to analyze and establish the suitability and safety of applying omentum to the breast. METHODS Covereing the interval from January 1984 to December 2013, we performed searches in MEDLINE, Embase, SciELO, and Google-Scholar for original articles describing the applicability of greater omentum to the breast and its clinical complications. RESULTS Sixty observational articles with 985 women were chosen. The main clinical indications were total breast reconstruction after mastectomy due to breast cancer (45 studies), radiation damage (23 studies), and congenital Poland syndrome (4 studies). Altogether, 273 complications were identified among the 985 women treated. The most frequent was flap necrosis (26.74 %). The most serious was injury to the digestive system (1.10 %). There was a 35.48 % incidence of local breast cancer recurrence in eight observational studies on oncological risk. Seven of the eight included only women with advanced cancer. One of these studies reported the incidence and relapse time predominantly according to the primary tumor size. CONCLUSIONS Although the oncological risk remains unclear, there was a high volume of complications that affected the digestive system. These findings suggest that omentum has well established applicability, but only for total breast reconstruction of huge defects, where muscular/myocutaneous or perforator flaps may be unsuitable.
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Affiliation(s)
- Francisco Claro
- Department of Gynecology and Obstetrics, School of Medical Sciences, State University of Campinas - UNICAMP, Rua Alexander Fleming, 101, Campinas, 13083-881, SP, Brazil,
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Bagheri R, Haghi SZ, Kalantari MR, Sharifian Attar A, Salehi M, Tabari A, Soudaneh M. Primary malignant chest wall tumors: analysis of 40 patients. J Cardiothorac Surg 2014; 9:106. [PMID: 24947314 PMCID: PMC4079176 DOI: 10.1186/1749-8090-9-106] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2013] [Accepted: 04/24/2014] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Primary chest wall tumors originate from different constructions of thoracic wall. We report our multidisciplinary experience on primary thoracic tumor resection and thoracic reconstruction, the need to additional therapy and evaluating prognostic factors affecting survival. METHODS We performed a retrospective review of our prospectively maintained database of 40 patients treated for malignant primary chest wall tumor from 1989 to 2009. Patients were evaluated in terms of age, sex, clinical presentation, type of imaging, tissue diagnosis methods, pathology, surgical technique, early complications, hospital mortality, prevalence of recurrence and distant metastases, additional treatment, 3 years survival and factors affecting survival. RESULTS Male/Female (F/M) = 1, with median age of 43.72 years. Mass was the most common symptoms and the soft tissue sarcoma was the most common pathology. Resection without reconstruction was performed in 5 patients and Thirty-five patients (87.5%) had extensive resection and reconstruction with rotatory muscular flap, prosthetic mesh and/or cement. Overall, 12.5% (5/40) of patients received neoadjuvant therapy and 75% (30/40) of patients were treated with adjuvant therapy. The 3-year survival rate was 65%. Recurrences occurred in 24 patients (60%), 14 developed local recurrences, and 10 developed distant metastases. The primary treatment modality for both local and distant recurrences was surgical resection; among them, 10 underwent repeated resection, 9 adjuvant therapy and 5 were treated with lung metastasectomy. The most common site of distant metastasis was lung (n = 7). Factors that affected survival were type of pathology and evidence of distant metastasis. CONCLUSION Surgery with wide margin is the safe and good technique for treatment of primary chest wall tumors with acceptable morbidity and mortality.
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Affiliation(s)
- Reza Bagheri
- Cardio-Thoracic Surgery & Transplant Research Center, Emam Reza hospital, Faculty of medicine, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Seyed Ziaollah Haghi
- Cardio-Thoracic Surgery & Transplant Research Center, Emam Reza hospital, Faculty of medicine, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Mahmoud reza Kalantari
- Cardio-Thoracic Surgery & Transplant Research Center, Emam Reza hospital, Faculty of medicine, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Alireza Sharifian Attar
- Endoscopic & Minimally Invasive Surgery Research Center, Department of Anesthesiology, Ghaem Hospital, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Maryam Salehi
- Solid Tumor Treatment Research Center, Omid Hospital, Faculty of medicine, Department of community medicine, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Azadeh Tabari
- Mashhad University of Medical Sciences, Mashhad, Iran
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Non-rigid reconstruction of chest wall defects after resection of musculoskeletal tumors. Surg Today 2014; 45:150-5. [DOI: 10.1007/s00595-014-0871-y] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2013] [Accepted: 01/21/2014] [Indexed: 12/23/2022]
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Full thickness thoracic wall reconstruction after oncologic surgery. EUROPEAN JOURNAL OF PLASTIC SURGERY 2013. [DOI: 10.1007/s00238-013-0820-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Brunbjerg ME, Juhl AA, Damsgaard TE. Chest wall reconstruction with acellular dermal matrix (Strattice(™)) and a TRAM flap. Acta Oncol 2013; 52:1052-4. [PMID: 23095144 DOI: 10.3109/0284186x.2012.734925] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Kalab M, Molitor M, Kubesova B, Lonsky V. Use of allogenous bone graft and osteosynthetic stabilization in treatment of massive post-sternotomy defects. Eur J Cardiothorac Surg 2012; 41:e182-4. [PMID: 22518044 DOI: 10.1093/ejcts/ezs077] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Thoracic stabilization using transverse plate fixation represents a modern and safe method of sternal dehiscence treatment. However, it still remains difficult to apply in cases of massive loss of bone tissue of the chest wall. An unsatisfactory stability of thorax often results in severe respiratory insufficiency, and also affects healing of soft tissue closure while increasing the risk of development of chronic fistulas and other dehiscences. In the reported case, we opted for a unique treatment of massive post-sternotomy defect using an allogenous bone graft of calva. Transverse titanium plates were applied to achieve stabilization of bone grafts and chest wall.
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Affiliation(s)
- Martin Kalab
- Department of Cardiac Surgery, University Hospital and Faculty of Medicine, Palacky University, Olomouc, Czech Republic.
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