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Falkner F, Thomas B, Mayer SA, Didzun O, Knoedler L, Panayi AC, Hundeshagen G, Vollbach FH, Gazyakan E, Kneser U, Bigdeli AK. The free vastus lateralis-And conjoined vastus lateralis anterolateral thigh/tensor fascia lata flap for oncological chest wall reconstruction. Microsurgery 2024; 44:e31212. [PMID: 39046178 DOI: 10.1002/micr.31212] [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: 12/14/2023] [Revised: 05/17/2024] [Accepted: 07/05/2024] [Indexed: 07/25/2024]
Abstract
INTRODUCTION A reconstructive option for extensive chest wall reconstruction is the free myocutaneous vastus lateralis muscle (VL) flap which can be performed in isolation or in conjunction with a fasciocutaneus anterolateral thigh (cVLALT) and/or myofasciocutaneous tensor fascia lata flap (cVLTFL). We aimed to directly compare the outcomes of these reconstructive options. METHODS Patients who underwent oncological chest wall reconstruction with a free VL, cVLALT, or cVLTFL flap between February 2010 and 2022 were included in this retrospective study. Patient demographics, surgical characteristics, as well as medical and reconstructive outcomes, were evaluated. The operative outcomes between myocutaneous VL, cVLALT, and cVLTFL flap reconstructions were compared. RESULTS A total of 41 patients underwent chest wall reconstruction with a free myocutaneous VL (n = 25; 61%), cVLALT (n = 14; 34%), or cVLTFL Three acute flap thromboses occurred in the entire cohort (3/41, 7%), with one myocutaneous VL flap failing because of recurrent venous thrombosis during the salvage procedure. Total flap necrosis was seen in two cases (5%; VL flap: n = 1; cVLALT flap: n = 1), and partial flap necrosis in one VL flap (1/25, 4%) and in the distal ALT portion of three cVLALT flaps (3/14, 21%). No significant difference was seen between isolated VL and conjoined VL flaps regarding the partial (p = .28) or total flap necrosis rate (p = .9). CONCLUSION The free (conjoined) VL flap provides reliable outcomes for obliterating dead space achieving durable reconstruction of complex chest wall defects.
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Affiliation(s)
- Florian Falkner
- Department of Hand, Plastic and Reconstructive Surgery, Burn Center, BG Center Ludwigshafen, Ludwigshafen, Germany
- Department of Hand and Plastic and Surgery, Heidelberg University, Heidelberg, Germany
| | - Benjamin Thomas
- Department of Hand, Plastic and Reconstructive Surgery, Burn Center, BG Center Ludwigshafen, Ludwigshafen, Germany
- Department of Hand and Plastic and Surgery, Heidelberg University, Heidelberg, Germany
| | - Simon A Mayer
- Department of Hand, Plastic and Reconstructive Surgery, Burn Center, BG Center Ludwigshafen, Ludwigshafen, Germany
- Department of Hand and Plastic and Surgery, Heidelberg University, Heidelberg, Germany
| | - Oliver Didzun
- Department of Hand, Plastic and Reconstructive Surgery, Burn Center, BG Center Ludwigshafen, Ludwigshafen, Germany
- Department of Hand and Plastic and Surgery, Heidelberg University, Heidelberg, Germany
| | - Leonard Knoedler
- Department of Hand, Plastic and Reconstructive Surgery, Burn Center, BG Center Ludwigshafen, Ludwigshafen, Germany
- Department of Hand and Plastic and Surgery, Heidelberg University, Heidelberg, Germany
| | - Adriana C Panayi
- Department of Hand, Plastic and Reconstructive Surgery, Burn Center, BG Center Ludwigshafen, Ludwigshafen, Germany
- Department of Hand and Plastic and Surgery, Heidelberg University, Heidelberg, Germany
| | - Gabriel Hundeshagen
- Department of Hand, Plastic and Reconstructive Surgery, Burn Center, BG Center Ludwigshafen, Ludwigshafen, Germany
- Department of Hand and Plastic and Surgery, Heidelberg University, Heidelberg, Germany
| | - Felix H Vollbach
- Department of Hand, Plastic and Reconstructive Surgery, Burn Center, BG Center Ludwigshafen, Ludwigshafen, Germany
- Department of Hand and Plastic and Surgery, Heidelberg University, Heidelberg, Germany
- Division of Hand, Plastic and Aesthetic Surgery, Ludwig-Maximilians-University (LMU), Munich, Germany
| | - Emre Gazyakan
- Department of Hand, Plastic and Reconstructive Surgery, Burn Center, BG Center Ludwigshafen, Ludwigshafen, Germany
- Department of Hand and Plastic and Surgery, Heidelberg University, Heidelberg, Germany
| | - Ulrich Kneser
- Department of Hand, Plastic and Reconstructive Surgery, Burn Center, BG Center Ludwigshafen, Ludwigshafen, Germany
- Department of Hand and Plastic and Surgery, Heidelberg University, Heidelberg, Germany
| | - Amir K Bigdeli
- Department of Hand, Plastic and Reconstructive Surgery, Burn Center, BG Center Ludwigshafen, Ludwigshafen, Germany
- Department of Hand and Plastic and Surgery, Heidelberg University, Heidelberg, Germany
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Blanco MD, de la Torre M, Lorca C, Del Cañizo A, Bada I, Monje S, García-Casillas MA, Villa Á, de Tomás E, Berenguer B. Use of pedicled flaps after oncologic resections in pediatric patients. Pediatr Surg Int 2024; 40:64. [PMID: 38433161 DOI: 10.1007/s00383-024-05654-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 02/11/2024] [Indexed: 03/05/2024]
Abstract
The aim of this study is to review the indications of pedicled flaps and analyze the results. A observational retrospective study of under 18-year-old oncology patients who required reconstructive surgery with pedicled flaps between 2011 and 2022 was performed. Demographic and clinical variables, indications, complications, and outcomes were collected. 236 patients were reviewed and 13 met inclusion criteria, eight girls and five boys (mean age: 10.6 years). Indications were Ewing's sarcoma (5), osteosarcoma (5), neuroblastoma, desmoid tumor, and neurofibroma. Preoperative PET-CT, MRI and bone scintigraphy were performed. The flaps were used on costal and extremity reconstruction: latissimus dorsi (5), pectoralis (2), medial gastrocnemius (2), combined latissimus dorsi, trapezius and serratus muscle, biceps femoris, fascio-neuro-cutaneous saphenous and cutaneous advancement-rotation. Two were performed on allograft and eight on prosthesis. All allowed immediate and complete closure. Six patients received intraoperative radiotherapy. One flap infection and two vascular complications were reported, a total necrosis, which required a new flap, and a partial necrosis, treated with a local plasty. Chemotherapy was resumed after 21 days (15-31). Mean follow-up time was 5.34 years. Flaps are an effective therapeutic option allowing reconstruction of large defects after pediatric oncologic surgeries. The most frequent complication was vascular.
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Affiliation(s)
- María Dolores Blanco
- General and Thoracic Pediatric Surgery Department, Hospital General Universitario Gregorio Marañón, Madrid, Spain.
- Department of Pediatric Surgery, Hospital Materno Infantil Gregorio Marañón, C/O'Donnell, 48, 28009, Madrid, Spain.
| | - Manuel de la Torre
- Plastic Pediatric Surgery Department, Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | - Concepción Lorca
- Plastic Pediatric Surgery Department, Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | - Agustín Del Cañizo
- General and Thoracic Pediatric Surgery Department, Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | - Isabel Bada
- General and Thoracic Pediatric Surgery Department, Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | - Sara Monje
- General and Thoracic Pediatric Surgery Department, Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | | | - Ángel Villa
- Pediatric Traumatology Department Hospital General, Universitario Gregorio Marañón, Madrid, Spain
| | - Elena de Tomás
- Plastic Pediatric Surgery Department, Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | - Beatriz Berenguer
- Plastic Pediatric Surgery Department, Hospital General Universitario Gregorio Marañón, Madrid, Spain
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Cammarata E, Toia F, Maltese M, Rossi M, Tripoli M, Cordova A. Soft tissue reconstruction of the trunk with pedicled perforator and musculocutaneous flaps: A single-center comparative retrospective study. Microsurgery 2024; 44:e31131. [PMID: 38009980 DOI: 10.1002/micr.31131] [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: 04/05/2023] [Revised: 10/12/2023] [Accepted: 10/26/2023] [Indexed: 11/29/2023]
Abstract
BACKGROUND Soft tissue trunk reconstruction is often challenging. Although free microvascular flaps are a feasible option in case of extensive defects involving deep structures, pedicled flaps represent a good alternative, especially if harvested and dissected with a "microsurgical" approach. The aim of this study is to evaluate the feasibility of trunk reconstruction with the use of pedicled flaps, according to the application of our reconstructive algorithm, and to compare it to other reconstructive methods. PATIENTS AND METHODS From January 2017 to December 2021, we retrospectively analyzed patients who underwent soft tissue reconstruction of the trunk with pedicled flaps at the authors' institution. Patient's demographic, clinical and surgical characteristics and postoperative complications were recorded and analyzed by descriptive statistics. A comparative analysis was made between the study group and two other groups who underwent reconstruction of trunk defects with free flaps and skin grafts, respectively, at the authors' institution. RESULTS Forty-seven patients were included in the study. Patients' age ranged between 36 and 82 years (mean: 57.8 years). Twenty-eight patients were male, while 19 patients were female. In 76.6% of patients (36 out of 47), reconstructive procedures were performed to repair defects resulting from cancer resection. Reconstruction of superficial defects was always achieved with perforator flaps (n = 25). In case of full-thickness defects, reconstruction was carried out with musculocutaneous flaps (n = 22); latissimus dorsi and vastus lateralis were the most used flaps for chest and abdominal wall reconstruction, respectively. In our series, we observed only one case of total flap loss requiring re-operation under general anesthesia. Minor complications occurred in 8.5% of cases (4 out of 47 patients). We observed two cases of partial flap necrosis and two cases of wound dehiscence. In the skin grafts group (n = 53), the mean age was 54.5 years (range 39-85) and 56% of patients were male (n = 30). In 66% of cases (n = 30) the defect resulted from oncological resection. The overall complication rate was 18.8% (n = 10). In the free flaps group (n = 10), the mean age was 49.0 years (range 29-77) and 60% of patients (n = 6) were male. In 70% of cases (n = 7) the defect was caused by oncological resection. Complications occurred in two patients (20%). No statistically significant differences were found in terms of overall complication rate between the study group and the two comparative groups (p = .48). A significant correlation was found between the reconstructive method and the type and size of the defect, with reconstruction through free flaps being associated with larger (344.0 vs. 220.4 cm2 ) (p = .04) and full-thickness defects (80.0% vs. 46.8%) (p < .01) if compared to pedicled flaps. CONCLUSIONS In the new era of microsurgery, pedicled flaps represent a valid alternative to free flaps for the majority of soft tissue defects of the trunk. In our series, no statistically significant differences in terms of complications were found between reconstructions of similar defects achieved with pedicled and free flaps, and free flap use was limited to extensive full-thickness defects. In addition, the rate of postoperative complications with pedicled flaps found in our cohort was lower than the rate reported in the literature.
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Affiliation(s)
- Emanuele Cammarata
- Plastic and Reconstructive Surgery, Department of Surgical, Oncological and Oral Sciences (Di.Chir.On.S.), University of Palermo, Palermo, Italy
| | - Francesca Toia
- Plastic and Reconstructive Surgery, Department of Surgical, Oncological and Oral Sciences (Di.Chir.On.S.), University of Palermo, Palermo, Italy
| | - Martina Maltese
- Plastic and Reconstructive Surgery, Department of Surgical, Oncological and Oral Sciences (Di.Chir.On.S.), University of Palermo, Palermo, Italy
| | - Matteo Rossi
- Plastic and Reconstructive Surgery, Department of Surgical, Oncological and Oral Sciences (Di.Chir.On.S.), University of Palermo, Palermo, Italy
| | - Massimiliano Tripoli
- Plastic and Reconstructive Surgery, Department of Surgical, Oncological and Oral Sciences (Di.Chir.On.S.), University of Palermo, Palermo, Italy
| | - Adriana Cordova
- Plastic and Reconstructive Surgery, Department of Surgical, Oncological and Oral Sciences (Di.Chir.On.S.), University of Palermo, Palermo, Italy
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The Best of Chest Wall Reconstruction: Principles and Clinical Application for Complex Oncologic and Sternal Defects. Plast Reconstr Surg 2022; 149:547e-562e. [PMID: 35196698 DOI: 10.1097/prs.0000000000008882] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
LEARNING OBJECTIVES After studying this article, the participant should be able to: 1. Appraise and evaluate risk factors for respiratory compromise following oncologic resection. 2. Outline and apply an algorithmic approach to reconstruction of the chest wall based on defect composition, size, and characteristics of surrounding tissue. 3. Recognize and evaluate indications for and types of skeletal stabilization of the chest wall. 4. Critically consider, compare, and select pedicled and free flaps for chest wall reconstruction that do not impair residual respiratory function or skeletal stability. SUMMARY Chest wall reconstruction restores respiratory function, provides protection for underlying viscera, and supports the shoulder girdle. Common indications for chest wall reconstruction include neoplasms, trauma, infectious processes, and congenital defects. Loss of chest wall integrity can result in respiratory and cardiac compromise and upper extremity instability. Advances in reconstructive techniques have expanded the resectability of large complex oncologic tumors by safely and reliably restoring chest wall integrity in an immediate fashion with minimal or no secondary deficits. The purpose of this article is to provide the reader with current evidenced-based knowledge to optimize care of patients requiring chest wall reconstruction. This article discusses the evaluation and management of oncologic chest wall defects, reviews controversial considerations in chest wall reconstruction, and provides an algorithm for the reconstruction of complex chest wall defects. Respiratory preservation, semirigid stabilization, and longevity are key when reconstructing chest wall defects.
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Nardi WS, Buero A, Pankl L, Quildrian SD. En-bloc resection of soft-tissue sarcoma of anterior chest wall and reconstruction with titanium bars and free anterolateral thigh flap. BMJ Case Rep 2021; 14:14/7/e241603. [PMID: 34266816 DOI: 10.1136/bcr-2021-241603] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Primary soft-tissue sarcomas (STSs) of the chest wall are uncommon. Complete surgical resection remains the mainstay of treatment being sternal resection ocassionally required. We present a 25-year-old man with an anterior chest wall STS. The patient underwent complete oncological resection with reconstruction using titanium bars combined with a free vascularised anterolateral thigh flap. STSs of the chest wall are very rare and they comprise a surgical challenge for both resection and reconstruction.
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Affiliation(s)
- Walter Sebastián Nardi
- Sarcoma and Melanoma Unit - General Surgery Department, Hospital Britanico de Buenos Aires, Buenos Aires, Argentina
| | - Agustin Buero
- Thoracic Surgery Department, Hospital Británico de Buenos Aires, Buenos Aires, Argentina
| | - Leonardo Pankl
- Thoracic Surgery Department, Hospital Británico de Buenos Aires, Buenos Aires, Argentina
| | - Sergio Damián Quildrian
- Sarcoma and Melanoma Unit - General Surgery Department, Hospital Britanico de Buenos Aires, Buenos Aires, Argentina
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Abdel Jalil R, Abou Chaar MK, Al-Qudah O, Kakish H, Elfar S. Chest wall and diaphragm reconstruction; a technique not well established in literature - case report. J Cardiothorac Surg 2021; 16:196. [PMID: 34243804 PMCID: PMC8272294 DOI: 10.1186/s13019-021-01577-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2021] [Accepted: 07/03/2021] [Indexed: 11/15/2022] Open
Abstract
INTRODUCTION Regardless of its rarity, and indolent clinical course, chest wall tumor places high morbidity and burden on patients especially when invasion to a neighboring structure is found. Once detected, surgery is the cornerstone for treatment of such etiology combined with chemo-radiotherapy. In order to maintain intact respiratory function, chest wall reconstruction must be performed whenever resection is done. Herein, we present a case of chest wall tumor that necessitated three ribs and part of hemidiaphragm resection and reconstruction with optimal post-operative results. CASE PRESENTATION A 27-year-old male patient who had chest wall and diaphragm reconstruction for a chest wall Ewing sarcoma, using a single patch of expanded polytetrafluoroethylene (ePTFE) mesh with diaphragm implanted into the middle of the mesh. There were no immediate nor post-operative complications. The patient received post-operative radiotherapy with good functional and cosmetic results. CONCLUSION We present a novel and safe technique for combined chest wall and diaphragmatic resection following excision of an invading tumor while ensuring cosmesis and functionality of the ribcage as well as the diaphragm.
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Affiliation(s)
- Riad Abdel Jalil
- Department of Thoracic Oncology, King Hussein Cancer Center, Queen Rania Al Abdullah Street, P.O. Box 1269, Amman, 11941, Jordan.
| | | | - Obada Al-Qudah
- Department of Thoracic Oncology, King Hussein Cancer Center, Queen Rania Al Abdullah Street, P.O. Box 1269, Amman, 11941, Jordan
| | - Hanna Kakish
- Department of Research, King Hussein Cancer Center, Amman, Jordan
| | - Salam Elfar
- Department of Pharmacy, King Hussein Cancer Center, Amman, Jordan
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Abbas A, Alaa MN. Ewing Sarcoma Family Tumors: Past, Present and Future Prospects. CURRENT CANCER THERAPY REVIEWS 2021. [DOI: 10.2174/1573394716999201125204643] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
Ewing’s sarcoma (ES), also known as mesenchymal primitive neuroectodermal tumor
(PNET), is a malignant round blue cell tumor (MRBCT) with a varying degree of neuronal differentiation.
PNET arises from the primitive nerve cells of the central nervous system (CNS) but may
also occur in the bones of the extremities, pelvis, vertebral column, and chest wall. Extraskeletal
ES/PNET may affect the various soft tissues, including those of the pelvis, paraspinal region, and
thoracopulmonary region.
Histopathological differentiation between ES, PNET, and other related sarcomas is often difficult.
On light microscopy, the same histopathological appearance of ES has been termed PNET, Askin-
Rosay (A-R) tumor, and malignant neuroepithelioma by various other authors. The immunohistochemical
distinction is also difficult due to poor tissue differentiation and low intake of the various
specific immunohistochemical markers. The most frequent translocation is t (11; 22) (q24; q12), resulting
in the EWSR1-FLI1 fusion gene detected in nearly 90% of cases and is considered the hallmark
of the diagnosis of ES, PNET, atypical ES, and A-R tumor. Therefore, ES, atypical ES,
PNET, and A-R tumor are currently regarded as one entity grouped together under the Ewing Family
Tumor (EFT) and are treated in an identical way. EFT represents only about 3% of all pediatric
malignancies. The annual incidence is between 2 and 5 cases per million children per year. The
peak prevalence of the tumor is between the ages of 10 and 15 years. The incidence is higher in
males than in females, with a ratio of 1.3:1.
Newer groups of MRBCT that have great similarities to EFT are being recently described. These tumors,
atypical EFT and Ewing’s like Sarcomas (ELS), bear similarities to EFT but have basic morphological
and molecular differences. Optimal treatment requires the use of adjuvant and new-adjuvant
chemotherapy (CTR), radical surgical resection and/or involves field radiotherapy (RT). The
reported disease-free survival (DFS) and overall survival (OS) range between 45-80% and 36-71%,
respectively. The overall prognosis for the metastatic and recurrent disease remains poor. The use
of newer conventional and targeted medications, improved RT delivery, and surgical techniques
may further improve the outcomes. The past few years have seen advances in genomics-based sarcoma
diagnosis and targeted therapies. In this comprehensive review article, we provide a detailed
report of EFT and discuss the various clinical aspects and the recent advances used in the diagnosis
and treatment.
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Affiliation(s)
- Adil Abbas
- College of Medicine, King Saud Bin Abdulaziz University for Health Sciences, The Pediatric Hematology/Oncology Setion, Princess Nourah Oncology Centre, King Abdulaziz Medical City, Jeddah, Saudi Arabia
| | - Mohammed N.S. Alaa
- Department of Laboratory Medicine, King Saud Bin Abdulaziz University for Health Sciences, King Abdulaziz Medical City, Jeddah, Saudi Arabia
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Tan Z, Zhang X, Ruan J, Liao J, Yu F, Xia L, Wang B, Liang C. Synthesis, structure, and properties of carbon/carbon composites artificial rib for chest wall reconstruction. Sci Rep 2021; 11:11285. [PMID: 34050262 PMCID: PMC8163812 DOI: 10.1038/s41598-021-90951-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2021] [Accepted: 05/17/2021] [Indexed: 01/10/2023] Open
Abstract
In this work, braided carbon fiber reinforced carbon matrix composites (3D-C/C composites) are prepared by chemical vapor infiltration process. Their composite structure, mechanical properties, biocompatibility, and in vivo experiments are investigated and compared with those of traditional 2.5D-C/C composites and titanium alloys TC4. The results show that 3D-C/C composites are composed of reinforced braided carbon fiber bundles and pyrolytic carbon matrix and provide 51% open pores with a size larger than 100 μm for tissue adhesion and growth. The Young's modulus of 3D-C/C composites is about 5 GPa, much smaller than those of 2.5D-C/C composites and TC4, while close to the autogenous bone. 3D-C/C composites have a higher tensile strength (167 MPa) and larger elongation (5.0%) than 2.5D-C/C composites (81 MPa and 0.7%), and do not show obvious degradation after 1 × 106 cyclic tensile loading. The 3D-C/C composites display good biocompatibility and have almost no artifacts on CT imaging. The in vivo experiment reveals that 3D-C/C composites artificial ribs implanted in dogs do not show displacement or fracture in 1 year, and there are no obvious proliferation and inflammation in the soft tissues around 3D-C/C composites implant. Our findings demonstrate that 3D-C/C composites are suitable for chest wall reconstruction and present great potentials in artificial bones.
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Affiliation(s)
- Zhoujian Tan
- State Key Laboratory for Powder Metallurgy, Central South University, Changsha, 410083, Hunan, People's Republic of China
| | - Xiang Zhang
- Hunan Tankang Biotech Co., LTD., Changsha, 410083, Hunan, People's Republic of China
| | - Jianming Ruan
- State Key Laboratory for Powder Metallurgy, Central South University, Changsha, 410083, Hunan, People's Republic of China
| | - Jiqiao Liao
- Hunan Tankang Biotech Co., LTD., Changsha, 410083, Hunan, People's Republic of China
| | - Fenglei Yu
- Department of Thoracic Surgery, The Second Xiangya Hospital, Central South University, Changsha, 410011, Hunan, People's Republic of China
| | - Lihong Xia
- College of Chemistry and Chemical Engineering, Central South University, Changsha, 410083, Hunan, People's Republic of China.
| | - Bin Wang
- Department of Thoracic Surgery, The Second Xiangya Hospital, Central South University, Changsha, 410011, Hunan, People's Republic of China.
| | - Chaoping Liang
- State Key Laboratory for Powder Metallurgy, Central South University, Changsha, 410083, Hunan, People's Republic of China
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Campanale A, Di Napoli A, Ventimiglia M, Pileri S, Minella D, Curigliano G, Martelli M, De Vita R, Di Giulio P, Montorsi M, Veronesi P, Giordano S, Iachino A, Lispi L. Chest wall infiltration is a critical prognostic factor in breast implant-associated anaplastic large-cell lymphoma affected patients. Eur J Cancer 2021; 148:277-286. [PMID: 33765512 DOI: 10.1016/j.ejca.2021.01.041] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2020] [Revised: 01/19/2021] [Accepted: 01/28/2021] [Indexed: 11/21/2022]
Abstract
BACKGROUND Breast implant-associated anaplastic large-cell lymphoma is a rare disease with a favourable prognosis if adequately treated. Same staged patients have usually a similar prognosis and outcomes, but in our experience, IIA-staged patients have a wider prognosis with outcomes that vary from complete disease response to death. This study aimed to understand and identify all the factors that could influence the prognosis of this group of patients and verify if their prognosis matches the stage they belong to. MATERIAL AND METHODS Patients in stage IIA have been divided into two subgroups: IIAb with lymphoma extension towards the glandular tissue and IIAcw with tumour extension towards the chest-wall. The overall survival (OS) and event-free survival (EFS) of 64 BIA-ALCL cases were evaluated for each staged group. RESULTS Significant differences of OS and EFS between IIAb and IIAcw patients (log-rank p = 0.046 and log-rank p = 0.018, respectively) were observed and poor prognosis joined IIAcw- and IV-staged patients. CONCLUSION Chest-wall infiltration is a critical prognostic factor in BIA-ALCL patients as it influences the possibility of performing a surgical radical tumour extirpation. Our results could represent valid assistance for the physicians in choosing the most appropriate BIA-ALCL prognostic category and treatment and could promote further wider studies to provide stronger evidence on a possible revision of the MDA TNM classification.
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Affiliation(s)
- Antonella Campanale
- Directorate General of Medical Device and Pharmaceutical Service - Italian Ministry of Health, Rome, Italy; Group of Experts on BIA-ALCL at the Italian Ministry of Health, Italy
| | - Arianna Di Napoli
- Group of Experts on BIA-ALCL at the Italian Ministry of Health, Italy; Department of Clinical and Molecular Medicine, Sapienza University, Sant'Andrea Hospital, Rome, Italy
| | - Marco Ventimiglia
- Directorate General of Medical Device and Pharmaceutical Service - Italian Ministry of Health, Rome, Italy
| | - Stefano Pileri
- Group of Experts on BIA-ALCL at the Italian Ministry of Health, Italy; Haematopathology Division, IEO, European Institute of Oncology IRCCS, Milan, Italy
| | - Daniela Minella
- Directorate General of Medical Device and Pharmaceutical Service - Italian Ministry of Health, Rome, Italy
| | - Giuseppe Curigliano
- Group of Experts on BIA-ALCL at the Italian Ministry of Health, Italy; Division of Early Drug Development for Innovative Therapies, IEO, European Institute of Oncology IRCCS, Milan, Italy; Department of Oncology and Haemato-Oncology, University of Milano, Milan, Italy.
| | - Maurizio Martelli
- Group of Experts on BIA-ALCL at the Italian Ministry of Health, Italy; Department of Translational and Precision Medicine "Sapienza" University, Rome, Italy
| | - Roy De Vita
- Group of Experts on BIA-ALCL at the Italian Ministry of Health, Italy; Plastic Surgery Department, National Institute for Cancer, Rome, Italy
| | - Paola Di Giulio
- Group of Experts on BIA-ALCL at the Italian Ministry of Health, Italy; Department of Public Health and Paediatrics, Turin University, Italy
| | - Marco Montorsi
- Group of Experts on BIA-ALCL at the Italian Ministry of Health, Italy; Humanitas University and Humanitas Research Center, IRCCS, Milan, Italy
| | - Paolo Veronesi
- Group of Experts on BIA-ALCL at the Italian Ministry of Health, Italy; Department of Oncology and Haemato-Oncology, University of Milano, Milan, Italy; Division of Breast Surgery, IEO, European Institute of Oncology IRCCS, Milan, Italy
| | - Silvia Giordano
- Group of Experts on BIA-ALCL at the Italian Ministry of Health, Italy; Department of Oncology, University of Torino and Candiolo Cancer Institute, FPO-IRCCS, Candiolo, Italy
| | - Achille Iachino
- Directorate General of Medical Device and Pharmaceutical Service - Italian Ministry of Health, Rome, Italy; Group of Experts on BIA-ALCL at the Italian Ministry of Health, Italy
| | - Lucia Lispi
- Directorate General of Medical Device and Pharmaceutical Service - Italian Ministry of Health, Rome, Italy; Group of Experts on BIA-ALCL at the Italian Ministry of Health, Italy
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Razafimanjato NNM, Ravelomihary TDN, Ranaivomanana M, Tsiambanizafy GO, Rakotovao HJL, Hunald FA. Surgical approach and prognosis of primitive chest wall alveolar rhabdomyosarcoma in an adult: A case report and review of the literature. JOURNAL OF CLINICAL AND INVESTIGATIVE SURGERY 2020. [DOI: 10.25083/2559.5555/5.2/104.108] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Alveolar rhabdomyosarcomas (ARMS) are rare entities that occur predominantly on the extremities and represent 20% of rhabdomyosarcomas. Other common locations include the peri-rectal and perineal regions, head and neck, and genitourinary system. To our knowledge, this presentation is the first case of alveolar rhabdomyosarcoma of the chest wall reported in the literature. Here, we describe a case of a 64-year-old man with alveolar rhabdomyosarcomas who underwent a chest wall resection. The defect was reconstructed with polypropylene mesh and latissimus dorsi muscle. Our patient did not show recurrence ten months after complete resection. The present paper describes our surgical approach to a case of primary alveolar rhabdomyosarcoma of the chest wall in an adult. The authors discuss the principal judgment criteria for successful surgical resection and prognosis, highlighting the relevance of chest wall reconstruction and their complementary aspects in the multimodal management of this rare entity.
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11
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da Costa Vieira RA, de Oliveira-Junior I, Branquinho LI, Haikel RL, Ching AW. Modified External Oblique Myocutaneous Flap for Repair of Postmastectomy Defects in Locally Advanced Breast Tumors: A Cohort Series Associated with a Systematic Review of Literature. Ann Surg Oncol 2020; 28:3356-3364. [PMID: 33063264 DOI: 10.1245/s10434-020-09205-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2020] [Accepted: 09/14/2020] [Indexed: 11/18/2022]
Abstract
BACKGROUND Locally advanced breast tumors (LABT) are situations of difficult resolution in clinical practice. External oblique myocutaneous flap (EOMF) is an option, but there are few studies in the literature on its use. METHODS This was a retrospective, cohort institutional study of patients with LABT who were undergoing mastectomy combined with the use of modified-EOMF (M-EOMF). Preoperative indications and conditions, factors associated with surgery, time to radiotherapy, local recurrence, and survival were assessed. A systematic review of the literature also was performed to evaluate the use of EOMF. RESULTS Over the 10-year period, 17 patients underwent M-EOMF closure. The mean duration of surgery was 251 min, and extensive skin area was resected (mean 468 ± 260 cm2). Four patients developed local recurrence. The actuarial survival at 36 months was 48.3%. Using PRISMA statement, among 115 articles evaluated from 3 databases, 8 articles were selected, in which 146 patients underwent EOMF. EOMF are associated with low postoperative complications with 8.9% skin necrosis. The M-EOMF allowed the resection of larger areas than other flaps described in the literature but is associated with skin necrosis. CONCLUSIONS M-EOMF has the advantages of not requiring a change in the patient's position for the closure of large areas. It is thus an acceptable option for chest wall reconstruction in tumors at the limit of resectability.
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Affiliation(s)
- René Aloisio da Costa Vieira
- Postgraduate Program of Oncology, Barretos Cancer Hospital, Barretos, SP, Brazil. .,Postgraduate Program Tocoginecology, Botucatu Medical School, Sao Paulo State University - UNESP, São Paulo, Brazil.
| | - Idam de Oliveira-Junior
- Postgraduate Program Tocoginecology, Botucatu Medical School, Sao Paulo State University - UNESP, São Paulo, Brazil.,Department of Mastology and Breast Reconstruction, Barretos Cancer Hospital, São Paulo, Brazil
| | | | - Raphael Luiz Haikel
- Department of Mastology and Breast Reconstruction, Barretos Cancer Hospital, São Paulo, Brazil
| | - An Wan Ching
- Department of Plastic Surgery, Federal University of São Paulo (UNIFESP), São Paulo, Brazil
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12
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The surgical management of sarcomas of the chest wall: A 13-year single institution experience. J Plast Reconstr Aesthet Surg 2020; 73:1448-1455. [DOI: 10.1016/j.bjps.2020.02.036] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2019] [Revised: 01/19/2020] [Accepted: 02/16/2020] [Indexed: 11/22/2022]
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13
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Brito ÍM, Teixeira S, Paupério G, Choupina M, Ribeiro M. Giant chondrosarcoma of the chest wall: a rare surgical challenge. AUTOPSY AND CASE REPORTS 2020; 10:e2020166. [PMID: 33344295 PMCID: PMC7703468 DOI: 10.4322/acr.2020.166] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
The chest wall chondrosarcoma (CWC) is a rare slowly growing primary tumor of the chest wall with an incidence of <0.5 per million person-years. We present the case of a giant CWC that caused a mass effect on the mediastinum, heart, and lung. Large tumors with thoracic structures compression may be life threatening, and its resection and subsequent chest wall reconstruction represent a significant multidisciplinary surgical challenge. In this case, despite the large tumor dimensions, the preoperative planning—sparing key reconstructive options without compromising the tumor resection—allowed a complete en bloc tumor excision of a grade III chondrosarcoma with negative histologic margins. Successful reconstruction of the large full-thickness chest wall defect, with a latissimus dorsi muscle flap and methyl methacrylate incorporated into a polypropylene mesh in a sandwich fashion, was accomplished. Patient recovery was uneventful with good functional and aesthetic outcomes, and no evidence of recurrence at 1.5 years follow-up. This case report illustrates the main clinical, radiological, and histologic features of a CWC while discussing the surgical goals and highlighting the principles for chest wall reconstruction following extensive resection of a large and rare entity.
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Affiliation(s)
- Íris M Brito
- Coimbra University Hospital Center, Department of Plastic Surgery and Burns Unit. Coimbra, Portugal
| | - Sérgio Teixeira
- São João Hospital Center, Department of Plastic, Reconstructive and Maxillo-Facial Surgery. Porto, Portugal
| | - Gonçalo Paupério
- Portuguese Institute of Oncology - Porto, Department of Thoracic Surgery. Porto, Portugal
| | - Miguel Choupina
- Portuguese Institute of Oncology - Porto, Department of Plastic and Reconstructive Surgery. Porto, Portugal
| | - Matilde Ribeiro
- Portuguese Institute of Oncology - Porto, Department of Plastic and Reconstructive Surgery. Porto, Portugal
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14
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Ciudad P, Huayllani MT, Forte AJ, Avila FR, Chen HC. Combined Free Fibula Osteocutaneous and Anterolateral Thigh-Vastus Lateralis Free Flaps for Clavicule and Extensive Chest Wall Reconstruction After Sarcoma Resection. Cureus 2020; 12:e8391. [PMID: 32637273 PMCID: PMC7331900 DOI: 10.7759/cureus.8391] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
Combined extensive chest and neck reconstructions is a challenging procedure. The rapid development in microvascular surgery has allowed the cancer surgeons to successfully resect and reconstruct advanced malignancies in the neck and thoracic region. Herein we present a young female diagnosed with malignant mesenchymal sarcoma of the right side of the neck extending to right upper lung and anterior mediastinum. The patient was successfully treated with two microvascular free flaps in a multidisciplinary approach. Wide local resection of the tumor was done along with removal of right upper pulmonary lobe and the subclavian vessels. Vascular reconstruction was done with polytetrafluoroethylene grafts. A free fibula osteocutaneous flap was used for stabilization and reconstruction of the clavicle. Anterolateral thigh flap with vastus lateralis muscle was used for soft tissue reconstruction. All flaps survived and the patient had a good recovery at three months of follow-up. Future reports suggesting guidelines or algorithms for complex chest wall reconstruction should benefit of similar scenarios to the one reported here.
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Affiliation(s)
- Pedro Ciudad
- Plastic, Reconstructive and Burn Surgery, Arzobispo Loayza National Hospital, Lima, PER
| | | | | | | | - Hung-Chi Chen
- Plastic and Reconstructive Surgery, China Medical University Hospital, Taichung, TWN
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15
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Combined anterolateral thigh and tensor fasciae latae flap using intraflap flow-through anastomoses in a case of chest wall reconstruction. EUROPEAN JOURNAL OF PLASTIC SURGERY 2020. [DOI: 10.1007/s00238-019-01567-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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16
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Reconstruction of Oncologic Sternectomy Defects: Lessons Learned from 60 Cases at a Single Institution. PLASTIC AND RECONSTRUCTIVE SURGERY-GLOBAL OPEN 2020; 7:e2351. [PMID: 31942367 PMCID: PMC6952121 DOI: 10.1097/gox.0000000000002351] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2019] [Accepted: 06/03/2019] [Indexed: 11/26/2022]
Abstract
Oncologic sternectomy results in complex defects where preoperative planning is paramount to achieve best reconstructive outcomes. Although pectoralis major muscle flap (PMF) is the workhorse for sternal soft tissue coverage, additional flaps can be required. Our purpose is to evaluate defects in which other flaps beside PMF were required to achieve optimal reconstruction.
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17
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Ayyala HS, Mohamed OM, Therattil PJ, Lee ES, Keith JD. The forearm fillet flap: 'spare parts' reconstruction for forequarter amputations. CASE REPORTS IN PLASTIC SURGERY AND HAND SURGERY 2019; 6:95-98. [PMID: 31595221 PMCID: PMC6764346 DOI: 10.1080/23320885.2019.1666718] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/24/2019] [Accepted: 09/08/2019] [Indexed: 11/24/2022]
Abstract
Radical forequarter amputation is often performed for recurrent proximal extremity tumors. A free forearm fillet flap is used to provide excellent coverage of the resultant defect without donor site morbidity. Use of a free flap from the distal portion of the extremity with proximal tumor burden is safe and effective.
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Affiliation(s)
- Haripriya S Ayyala
- Division of Plastic Surgery, Department of Surgery, Rutgers New Jersey Medical School, Newark, NJ, USA
| | - Omar M Mohamed
- Division of Plastic Surgery, Department of Surgery, Rutgers New Jersey Medical School, Newark, NJ, USA
| | - Paul J Therattil
- Division of Plastic Surgery, Department of Surgery, Rutgers New Jersey Medical School, Newark, NJ, USA
| | - Edward S Lee
- Division of Plastic Surgery, Department of Surgery, Rutgers New Jersey Medical School, Newark, NJ, USA
| | - Jonathan D Keith
- Division of Plastic Surgery, Department of Surgery, Rutgers New Jersey Medical School, Newark, NJ, USA
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18
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Buschmann J, Yamada Y, Schulz-Schönhagen K, Hess SC, Stark WJ, Opelz C, Bürgisser GM, Weder W, Jungraithmayr W. Hybrid nanocomposite as a chest wall graft with improved integration by adipose-derived stem cells. Sci Rep 2019; 9:10910. [PMID: 31358841 PMCID: PMC6662805 DOI: 10.1038/s41598-019-47441-9] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2018] [Accepted: 07/15/2019] [Indexed: 02/07/2023] Open
Abstract
Surgery of the chest wall is potentially required to cover large defects after removal of malignant tumours. Usually, inert and non-degradable Gore-Tex serves to replace the missing tissue. However, novel biodegradable materials combined with stem cells are available that stimulate the healing. Based on poly-lactic-co-glycolic acid and amorphous calcium phosphate nanoparticles (PLGA/aCaP) and pure PLGA, a dual layer biodegradable hybrid nanocomposite was generated. Mouse adipose-derived stem cells were cultered on electrospun disks (ASCs of C57BL/6), and biomechanical tests were performed. The cell-seeded scaffolds were engrafted in C57BL/LY5.1 mice to serve as a chest wall substitute. Cell invasion into the bi-layered material, extent of CD45+ cells, inflammatory response, neo-vascularization and ECM composition were determined at 1 and 2 months post-surgery, respectively. The bi-layered hybrid nanocomposite was stable after a 2-week in vitro culture, in contrast to PLGA/aCaP without a PLGA layer. There was a complete biointegration and good vascularization in vivo. The presence of ASCs attracted more CD45+ cells (hematopoietic origin) compared to cell-free scaffolds. Inflammatory reaction was similar for both groups (±ASCs) at 8 weeks. A bi-layered hybrid nanocomposite fabricated of electrospun PLGA/aCaP and a reinforcing layer of pristine PLGA is an ideal scaffold for chest wall reconstruction. It is stable and allows a proper host tissue integration. If ASCs are seeded, they attract more CD45+ cells, supporting the regeneration process.
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Affiliation(s)
- Johanna Buschmann
- Division of Plastic and Hand Surgery, University Hospital Zurich, Zurich, Switzerland.
| | - Yoshito Yamada
- Department of Thoracic Surgery, University Hospital Zurich, Zurich, Switzerland
| | - Konstantin Schulz-Schönhagen
- Institute for Chemical and Bioengineering, Department of Chemistry and Applied Biosciences, ETH Zurich, CH-8093, Zurich, Switzerland
| | - Samuel C Hess
- Institute for Chemical and Bioengineering, Department of Chemistry and Applied Biosciences, ETH Zurich, CH-8093, Zurich, Switzerland
| | - Wendelin J Stark
- Institute for Chemical and Bioengineering, Department of Chemistry and Applied Biosciences, ETH Zurich, CH-8093, Zurich, Switzerland
| | - Christine Opelz
- Department of Thoracic Surgery, University Hospital Zurich, Zurich, Switzerland
| | | | - Walter Weder
- Department of Thoracic Surgery, University Hospital Zurich, Zurich, Switzerland
| | - Wolfgang Jungraithmayr
- Department of Thoracic Surgery, University Hospital Zurich, Zurich, Switzerland.,Department of Thoracic Surgery, University Hospital Rostock, Rostock, Germany
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19
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Malathi L, Das S, Nair JTK, Rajappan A. Chest wall reconstruction: success of a team approach-a 12-year experience from a tertiary care institution. Indian J Thorac Cardiovasc Surg 2019; 36:44-51. [PMID: 33061093 DOI: 10.1007/s12055-019-00841-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2019] [Revised: 05/16/2019] [Accepted: 05/24/2019] [Indexed: 10/26/2022] Open
Abstract
Background The thoracic cavity was considered as a forbidden area in the past and anyone attempting to meddle with it was expected to be doomed. But the past several decades have seen a marked improvement in the management and reconstruction of complex chest wall defects. This study was undertaken to review our experience in chest wall reconstruction during the past 12 years and to stress upon the importance of a multidisciplinary team approach to this complex problem. Methods After obtaining the necessary clearance from institutional ethics committee, we did a retrospective review of all case records of chest wall reconstructions (CWR) performed in our institution during a 12-year period from May 2005 to September 2016. Patient characteristics, co-morbidities, operative data and post-operative complications and outcomes were reviewed. Results During the study period, a total of 32 patients underwent CWR. All patients were assessed, planned, operated and managed by a team consisting of thoracic surgeons, plastic surgeons, intensivists and pulmonologists. Patients were in the age group of 14-72 with a male:female ratio of 15:17. Indications for CWR were neoplasms (n = 13-40.62%), post-sternotomy wound dehiscence (n = 12-37.5%), osteoradionecrosis (n = 4-12.5%), tuberculosis (n = 2-6.25%) and osteomyelitis rib (1/32-3.125%). Inflammatory defects were mostly closed with soft tissue alone whereas skeletal stabilisation with soft tissue cover was required in tumour resections. All were pedicled flaps, the most common being pectoralis major (PM) muscle flap (n = 12). Others include latissimus dorsi (LD) muscle (n = 9); rectus abdominis (RA) muscle (n = 2); transverse rectus abdominis musculocutaneous flap (TRAM) (n = 2), deltopectoral (DP) (n = 1), omentum (n = 3) and breast flap (n = 3). Post-operative complications include wound dehiscence (12%), wound infection (21%) and recurrent sinus formation (7%). One partial flap failure was recorded. Post-operative mortality was 3%. Conclusion Chest wall reconstruction is a complex procedure and each defect needs an individualised approach for optimum outcome. Extensive chest wall resections can be safely undertaken with the support of the reconstructive surgeon and with good critical care back up.
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Affiliation(s)
- Lekshmi Malathi
- Department of Plastic Surgery, Government Medical College Kottayam, Kottayam, Kerala India
| | - Sankar Das
- Department of Plastic Surgery, Government Medical College Kottayam, Kottayam, Kerala India
| | | | - Aniraj Rajappan
- Department of Plastic Surgery, Government Medical College Kottayam, Kottayam, Kerala India
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20
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Salo JTK, Repo JP, Roine RP, Sintonen H, Tukiainen EJ. Health-related quality of life after oncological resection and reconstruction of the chest wall. J Plast Reconstr Aesthet Surg 2019; 72:1776-1784. [PMID: 31201108 DOI: 10.1016/j.bjps.2019.05.040] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2018] [Revised: 04/10/2019] [Accepted: 05/16/2019] [Indexed: 11/29/2022]
Abstract
OBJECTIVES There is limited information of the health-related quality of life (HRQoL) after surgical treatment of chest wall tumors. This cross-sectional study aimed to assess long-term HRQoL after chest wall reconstruction following oncological resection. METHODS Seventy-eight patients having undergone chest wall tumor resection and reconstruction during 1997-2015 were invited to complete the 15D and QLQ-C30 HRQoL instruments. RESULTS Altogether, 55 patients (17 men and 38 women), with a mean (SD) age of 68 (14) years, completed the questionnaires (response rate 71%). Patients had been operated due to soft tissue sarcoma (n = 16), advanced breast cancer (n = 15), osteo- or chondrosarcoma (n = 14), or other tumor (n = 10). Median time after primary surgery was 66 (IQR 38, 141) months. The resection was full thickness in 29/55 cases and partial thickness in 26/55 cases. Chest wall reconstruction was required for 47/55 cases (85%). Reconstruction was performed using soft-tissue flap in eight cases, skeletal stabilizations with mesh or mesh-cement-mesh (sandwich method) in 15 cases, and skeletal stabilizations and soft-tissue flap in 24 cases. Patients' mean 15D score (0.878, SD 0.111) was comparable to that of the age- and gender-standardized general population (0.891, SD 0.041). Limitations in breathing and usual activities were noted. The QLQ-C30 cancer-specific HRQoL was 72 points (maximum 100). Scores in the QLQ-C30 Functional scales ranged from 78 (Physical) to 91 (Social). CONCLUSIONS Long-term HRQoL in patients after chest wall reconstruction following oncological resection is fair and comparable to that of the general population. Limitations in breathing and usual activities can occur.
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Affiliation(s)
- J T K Salo
- Department of Plastic Surgery, University of Helsinki and Helsinki University Hospital, Helsinki, Finland.
| | - J P Repo
- Department of Plastic Surgery, University of Helsinki and Helsinki University Hospital, Helsinki, Finland; Department of Surgery, Central Finland Health Care District, Jyväskylä, Finland
| | - R P Roine
- Group Administration, University of Helsinki and Helsinki University Hospital, Finland; Department of Health and Social Management, Research Centre for Comparative Effectiveness and Patient Safety, University of Eastern Finland, Kuopio, Finland
| | - H Sintonen
- Department of Public Health, University of Helsinki, Helsinki, Finland
| | - E J Tukiainen
- Department of Plastic Surgery, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
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21
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di Summa PG, Schaffer C, Tay SK, Weiler-Mithoff E. Chest resurfacing with a reverse abdominoplasty flap for invasive breast cancer recurrence. CASE REPORTS IN PLASTIC SURGERY AND HAND SURGERY 2019; 6:51-54. [PMID: 31069246 PMCID: PMC6493283 DOI: 10.1080/23320885.2019.1605293] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/11/2019] [Accepted: 04/05/2019] [Indexed: 11/01/2022]
Abstract
We present a patient with recurrent breast cancer requiring massive resection of the upper chest. Management included a reverse abdominoplasty flap to resurface the anterior chest wall, with acceptable aesthetic outcomes, and adjuvant chemotherapy. RA is a simple and versatile coverage option in patients with high risk of disease recurrence.
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Affiliation(s)
- Pietro G di Summa
- Department of Plastic, Reconstructive and Hand Surgery, University Hospital of Lausanne (CHUV), Lausanne, Switzerland.,Canniesburn Plastic Surgery Unit, Glasgow Royal Infirmary, Glasgow, United Kingdom
| | - Clara Schaffer
- Department of Plastic, Reconstructive and Hand Surgery, University Hospital of Lausanne (CHUV), Lausanne, Switzerland
| | - Sherilyn K Tay
- Canniesburn Plastic Surgery Unit, Glasgow Royal Infirmary, Glasgow, United Kingdom
| | - Eva Weiler-Mithoff
- Canniesburn Plastic Surgery Unit, Glasgow Royal Infirmary, Glasgow, United Kingdom
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22
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Hayashi T, Sakakura N, Ishimura D, Kozawa E, Yoshida M, Sakao Y, Yamada H, Tsukushi S. Surgical complication and postoperative pulmonary function in patients undergoing tumor surgery with thoracic wall resection. Oncol Lett 2019; 17:3446-3456. [PMID: 30867783 PMCID: PMC6396184 DOI: 10.3892/ol.2019.9997] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2018] [Accepted: 01/23/2019] [Indexed: 11/16/2022] Open
Abstract
Postoperative complications of thoracic wall resection include respiratory complications, skin necrosis and infection. The aim of the present study was to examine postoperative complications in patients who required combined thoracic wall resection during the surgical removal of a tumor. The present study included 68 patients; there were 50 patients with lung tumors and 18 patients with musculoskeletal tumors. The clinical factors associated with complications were compared between the two groups. Preoperative and postoperative pulmonary function tests were performed to examine the residual pulmonary function in 16 patients. Thoracic cage reconstruction was performed in 46 patients. Postoperative complications occurred in 30 (44.1%) patients, and one patient died from postoperative pneumonitis. Compared with the pulmonary function preoperative test results, the postoperative results revealed a decrease in the mean vital capacity percentage and an increase in the mean forced expiratory volume within 1 sec as a percent of the forced vital capacity. In patients with lung tumors, pneumonectomy can result in an increased rate of complications following thoracic wall resection. Residual pulmonary function is affected by impaired thoracic cage expansion and removal of the lung. However, the results of the present study demonstrated that these complications can be somewhat stabilized by thoracic wall reconstruction.
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Affiliation(s)
- Takuma Hayashi
- Department of Orthopedic Surgery, Aichi Cancer Center Hospital, Nagoya, Aichi 464-8681, Japan.,Department of Orthopedic Surgery, Fujita Health University, Toyoake, Aichi 470-1192, Japan
| | - Noriaki Sakakura
- Department of Respiratory Surgery, Aichi Cancer Center Hospital, Nagoya, Aichi 464-8681, Japan
| | - Daisuke Ishimura
- Department of Orthopedic Surgery, Fujita Health University, Toyoake, Aichi 470-1192, Japan
| | - Eiji Kozawa
- Department of Orthopedic Surgery, Aichi Cancer Center Hospital, Nagoya, Aichi 464-8681, Japan
| | - Masahiro Yoshida
- Department of Orthopedic Surgery, Aichi Cancer Center Hospital, Nagoya, Aichi 464-8681, Japan
| | - Yukinori Sakao
- Department of Respiratory Surgery, Aichi Cancer Center Hospital, Nagoya, Aichi 464-8681, Japan
| | - Harumoto Yamada
- Department of Orthopedic Surgery, Fujita Health University, Toyoake, Aichi 470-1192, Japan
| | - Satoshi Tsukushi
- Department of Orthopedic Surgery, Aichi Cancer Center Hospital, Nagoya, Aichi 464-8681, Japan
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23
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Fang L, Chen YJ, Wu GY, Zou QY, Wang ZG, Zhu G, Hu XM, Zhou B, Tang Y, Xiao GM. Ribs Formed by Prolene Mesh, Bone Cement, and Muscle Flaps Successfully Repair Chest Abdominal Wall Defects after Tumor Resection: A Long-term Study. Chin Med J (Engl) 2018; 130:1510-1511. [PMID: 28584220 PMCID: PMC5463487 DOI: 10.4103/0366-6999.207473] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Affiliation(s)
- Li Fang
- Department of Thoracic Surgery, The Affiliated Cancer Hospital of Xiangya School of Medicine, Central South University, Changsha, Hunan 410013, China
| | - Yue-Jun Chen
- Department of Thoracic Surgery, The Affiliated Cancer Hospital of Xiangya School of Medicine, Central South University, Changsha, Hunan 410013, China
| | - Guan-Yu Wu
- Department of Thoracic Surgery, The Affiliated Cancer Hospital of Xiangya School of Medicine, Central South University, Changsha, Hunan 410013, China
| | - Qiu-Yi Zou
- Department of Thoracic Surgery, The Affiliated Cancer Hospital of Xiangya School of Medicine, Central South University, Changsha, Hunan 410013, China
| | - Zhi-Gang Wang
- Department of Thoracic Surgery, The Affiliated Cancer Hospital of Xiangya School of Medicine, Central South University, Changsha, Hunan 410013, China
| | - Guang Zhu
- Department of Thoracic Surgery, The Affiliated Cancer Hospital of Xiangya School of Medicine, Central South University, Changsha, Hunan 410013, China
| | - Xing-Ming Hu
- Department of Thoracic Surgery, The Affiliated Cancer Hospital of Xiangya School of Medicine, Central South University, Changsha, Hunan 410013, China
| | - Bin Zhou
- Department of Thoracic Surgery, The Affiliated Cancer Hospital of Xiangya School of Medicine, Central South University, Changsha, Hunan 410013, China
| | - Yi Tang
- Department of Thoracic Surgery, The Affiliated Cancer Hospital of Xiangya School of Medicine, Central South University, Changsha, Hunan 410013, China
| | - Gao-Ming Xiao
- Department of Thoracic Surgery, The Affiliated Cancer Hospital of Xiangya School of Medicine, Central South University, Changsha, Hunan 410013, China
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25
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Sakurai T, Kusumoto H, Wakasa T, Ohta Y, Konishi E, Shiono H. Epithelioid sarcoma in the chest wall: a case report and literature review. Surg Case Rep 2018; 4:77. [PMID: 30006912 PMCID: PMC6045564 DOI: 10.1186/s40792-018-0483-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2018] [Accepted: 07/02/2018] [Indexed: 01/07/2023] Open
Abstract
BACKGROUND Epithelioid sarcoma (ES) is a rare variant of soft tissue sarcoma. The proximal type of ES occurs in various locations. We present a resected case with proximal-type ES that occurred in the chest wall and discuss the relevant literature. CASE PRESENTATION A 47-year-old woman was referred for a 6-month history of a right anterior chest mass with tenderness. Chest computed tomography showed an invasive chest wall mass with calcification surrounding the third rib. Aspiration biopsy cytology suggested malignancy. We performed wide resection, including the middle part of the pectoralis major muscle, the pectoralis minor muscle, the third and fourth ribs, and reconstruction of the chest wall, using a 2-mm polytetrafluoroethylene patch. Severe deformation of the chest wall was avoided. Postoperative physical therapy of the shoulder was effective for the continuous pain and weakness of the arm. She has remained alive for 1 year and 10 months without recurrence. Our literature review showed five previously reported cases of ES in the chest wall, and all of these were surgically resected. Two of these patients suffered from frequent local recurrence and died of disease. CONCLUSIONS ES in the chest wall is rare. Previous reports have indicated that surgical resection with tumor-free margins is essential for treatment. We performed complete resection of the tumor in our case, and a polytetrafluoroethylene patch was effective for reconstructing the deficit in the chest wall.
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Affiliation(s)
- Teiko Sakurai
- Department of General Thoracic Surgery, Kindai University Nara Hospital, Otoda-cho 1248-1, Ikoma, Nara, 630-0293, Japan.
| | - Hidenori Kusumoto
- Department of General Thoracic Surgery, Kindai University Nara Hospital, Otoda-cho 1248-1, Ikoma, Nara, 630-0293, Japan
| | - Tomoko Wakasa
- Diagnostic Pathology and Laboratory Medicine, Kindai University Nara Hospital, Otoda-cho 1248-1, Ikoma, Nara, 630-0293, Japan
| | - Yoshio Ohta
- Diagnostic Pathology and Laboratory Medicine, Kindai University Nara Hospital, Otoda-cho 1248-1, Ikoma, Nara, 630-0293, Japan
| | - Eiichi Konishi
- Department of Surgical Pathology, Kyoto Prefectural University of Medicine, Kajii-cho 465, Kawaramachi-Hirokoji, Kamigyo-ku, Kyoto, 602-8566, Japan
| | - Hiroyuki Shiono
- Department of General Thoracic Surgery, Kindai University Nara Hospital, Otoda-cho 1248-1, Ikoma, Nara, 630-0293, Japan
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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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Wen X, Gao S, Feng J, Li S, Gao R, Zhang G. Chest-wall reconstruction with a customized titanium-alloy prosthesis fabricated by 3D printing and rapid prototyping. J Cardiothorac Surg 2018; 13:4. [PMID: 29310677 PMCID: PMC5759864 DOI: 10.1186/s13019-017-0692-3] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2017] [Accepted: 12/29/2017] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND As 3D printing technology emerge, there is increasing demand for a more customizable implant in the repair of chest-wall bony defects. This article aims to present a custom design and fabrication method for repairing bony defects of the chest wall following tumour resection, which utilizes three-dimensional (3D) printing and rapid-prototyping technology. METHODS A 3D model of the bony defect was generated after acquiring helical CT data. A customized prosthesis was then designed using computer-aided design (CAD) and mirroring technology, and fabricated using titanium-alloy powder. The mechanical properties of the printed prosthesis were investigated using ANSYS software. RESULTS The yield strength of the titanium-alloy prosthesis was 950 ± 14 MPa (mean ± SD), and its ultimate strength was 1005 ± 26 MPa. The 3D finite element analyses revealed that the equivalent stress distribution of each prosthesis was unifrom. The symmetry and reconstruction quality contour of the repaired chest wall was satisfactory. No rejection or infection occurred during the 6-month follow-up period. CONCLUSION Chest-wall reconstruction with a customized titanium-alloy prosthesis is a reliable technique for repairing bony defects.
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Affiliation(s)
- Xiaopeng Wen
- Department of Thoracic Surgery, First Affiliated Hospital of Xi'an Jiaotong University, #277 West Yanta Road, Xi'an, Shaanxi Province, 710061, People's Republic of China
| | - Shan Gao
- Department of Thoracic Surgery, First Affiliated Hospital of Xi'an Jiaotong University, #277 West Yanta Road, Xi'an, Shaanxi Province, 710061, People's Republic of China
| | - Jinteng Feng
- Department of Thoracic Surgery, First Affiliated Hospital of Xi'an Jiaotong University, #277 West Yanta Road, Xi'an, Shaanxi Province, 710061, People's Republic of China
| | - Shuo Li
- Department of Thoracic Surgery, First Affiliated Hospital of Xi'an Jiaotong University, #277 West Yanta Road, Xi'an, Shaanxi Province, 710061, People's Republic of China
| | - Rui Gao
- Department of Thoracic Surgery, First Affiliated Hospital of Xi'an Jiaotong University, #277 West Yanta Road, Xi'an, Shaanxi Province, 710061, People's Republic of China
| | - Guangjian Zhang
- Department of Thoracic Surgery, First Affiliated Hospital of Xi'an Jiaotong University, #277 West Yanta Road, Xi'an, Shaanxi Province, 710061, People's Republic of China.
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Betancourt Cuellar SL, Heller L, Palacio DP, Hofstetter WL, Marom EM. Intra- and Extra-Thoracic Muscle Flaps and Chest Wall Reconstruction Following Resection of Thoracic Tumors. Semin Ultrasound CT MR 2017; 38:604-615. [PMID: 29179900 DOI: 10.1053/j.sult.2017.07.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Improvements in surgical technique over the last decade enable surgeons to perform extensive resection and reconstruction in patients presenting with tumors involving the soft tissue or bony structures of the chest wall. The type of surgical resection and its size, depend on the type of tumor resected and its location. In addition to providing a better esthetic result, the reconstruction restores support and functionality of the thoracic cage. The approach to chest wall repair includes primary closure or reconstruction by using transposition flaps, free flaps, prosthetic material, or a mixture of a flap and prosthetic material.
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Affiliation(s)
- Sonia L Betancourt Cuellar
- Department of Diagnostic Radiology, The University of Texas, MD Anderson Cancer Center, Houston, TX; Address reprint requests to Sonia L. Betancourt Cuellar, MD, Diagnostic Radiology Department, The University of Texas, MD Anderson Cancer Center, 1515 Holcombe Blvd, Houston, TX 77030.
| | - Lior Heller
- Department of Plastic Surgery, Assaf Harofeh Medical Center, Zerifin, Israel
| | - Diana P Palacio
- Department of Diagnostic Radiology, University of Arizona, Medical Center, Tucson, AZ
| | - Wayne L Hofstetter
- Department of Thoracic and Cardiovascular Surgery, The University of Texas, MD Anderson Cancer Center, Houston, TX
| | - Edith M Marom
- Department of Diagnostic Radiology, The University of Texas, MD Anderson Cancer Center, Houston, TX; Department of Diagnostic Imaging, The Chaim Sheba Medical Center, Ramat-Gan, Israel, affiliated with the Tel Aviv University, Israel
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Buschmann J, Balli E, Hess SC, Stark WJ, Cinelli P, Märsmann S, Welti M, Weder W, Jungraithmayr W. Effects of seeding adipose-derived stem cells on electrospun nanocomposite used as chest wall graft in a murine model. Injury 2017; 48:2080-2088. [PMID: 28842288 DOI: 10.1016/j.injury.2017.08.004] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/07/2016] [Accepted: 08/02/2017] [Indexed: 02/02/2023]
Abstract
Malignant neoplasms infiltrating the chest wall often requires resection of the thoracic wall. To replace the defect, Gore-Tex® is usually employed as the gold standard material, however, Gore-Tex® is inert and not degradable. Novel materials are nowadays available which allow a full bio-integration due to their non-toxic degradability. Additionally, stem cell seeding has the capacity to reduce inflammatory response towards such grafts, thus integrating it better into the host organism.
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Affiliation(s)
- Johanna Buschmann
- Division of Plastic and Hand Surgery, University Hospital Zurich, Switzerland.
| | - Eleni Balli
- Division of Plastic and Hand Surgery, University Hospital Zurich, Switzerland
| | - Samuel C Hess
- Institute for Chemical and Bioengineering, Department of Chemistry and Applied Biosciences, ETH Zurich, CH-8093 Zurich, Switzerland
| | - Wendelin J Stark
- Institute for Chemical and Bioengineering, Department of Chemistry and Applied Biosciences, ETH Zurich, CH-8093 Zurich, Switzerland
| | - Paolo Cinelli
- Division of Trauma Surgery, University Hospital Zurich, Switzerland
| | - Sonja Märsmann
- Division of Plastic and Hand Surgery, University Hospital Zurich, Switzerland; Division of Trauma Surgery, University Hospital Zurich, Switzerland
| | - Manfred Welti
- Division of Plastic and Hand Surgery, University Hospital Zurich, Switzerland; Division of Thoracic Surgery, University Hospital Zurich, Switzerland
| | - Walter Weder
- Division of Thoracic Surgery, University Hospital Zurich, Switzerland
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Kuwahara H, Salo J, Tukiainen E. Diaphragm reconstruction combined with thoraco-abdominal wall reconstruction after tumor resection. J Plast Surg Hand Surg 2017; 52:172-177. [PMID: 28857656 DOI: 10.1080/2000656x.2017.1372292] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
BACKGROUND Thoraco-abdominal wall resection including diaphragm resection results in a challenging surgical defect. Various methods have been used for diaphragm reconstruction. The aim of this study was to describe our methods of diaphragm and thoraco-abdominal wall reconstruction after combined resection of these anatomical structures. METHODS Twenty-one patients underwent diaphragm resection at our institution between 1997 and 2015. We used a mesh or direct closure for diaphragm defect and a mesh for chest wall stabilization. A pedicled or free flap for soft tissue coverage was used when direct closure was not possible. RESULTS Indications for resection were primary sarcoma (n = 14), cancer metastasis (n = 4), desmoid tumor (n = 2), and solitary fibrous tumor (n = 1). The median patient age was 58.9 years. The diaphragm was pulled to its original position and sutured directly (n = 15) or reconstructed with mesh (n = 6). Chest wall reconstructions were performed with a mesh (n = 14), mesh and a pedicled flap (n = 4), mesh and a free flap (n = 3). No perioperative mortality occurred. One-year and 5-year survival rates were 85.7 and 65.9%, respectively, while overall recurrence-free rates were 80.4 and 60.8%, respectively. CONCLUSIONS We have described our surgical methods for the resection of tumors of the chest or abdominal wall, including our method of distal diaphragm resection with wide or clear surgical margins. The method is safe and the reconstructions provided adequate stability, as well as water-tight and air-tight closure of the chest cavity. There were no cases of paradoxical movement of the chest or of diaphragm or thoraco-abdominal hernia.
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Affiliation(s)
- Hiroaki Kuwahara
- a Department of Plastic Surgery , Helsinki University Hospital , Helsinki , Finland.,b Department of Plastic, Reconstructive and Aesthetic Surgery , Nippon Medical School Hospital , Tokyo , Japan
| | - Juho Salo
- a Department of Plastic Surgery , Helsinki University Hospital , Helsinki , Finland
| | - Erkki Tukiainen
- a Department of Plastic Surgery , Helsinki University Hospital , Helsinki , Finland
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Zhang JQ, Zhang JM, Liang WQ, Ji CY, Chen YH. Lengthening the pedicle of the rectus abdominis myocutaneous flap for repair of upper chest and neck defects. Ann R Coll Surg Engl 2017; 99:464-471. [PMID: 28660811 DOI: 10.1308/rcsann.2017.0055] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
INTRODUCTION The aim of this study was to investigate whether the pedicle of the rectus abdominis flap can be lengthened by resecting the inferior costal cartilage segments or associated muscle when repairing upper body defects. A formula was generated that calculates the expected increase in pedicle length. METHODS Thirty patients underwent computed tomography. The width and thickness of the third to seventh inferior costal cartilage segments as well as the width of the respective intercostal spaces were recorded. Four patients underwent reconstruction of an upper body defect with the relevant flap. RESULTS The expected mean increases in pedicle length were 4.07cm (standard deviation [SD]: 0.31cm) and 4.63cm (SD: 0.54cm) following resection of the left and right sides respectively of the seventh inferior costal cartilage segment, 7.99cm (SD: 0.49cm) and 10.82cm (SD: 0.23cm) following resection of the left and right sides respectively of the sixth and seventh inferior costal cartilage segments while resection of the fourth to seventh inferior costal cartilage segments would equate to increases of 17.48cm (SD: 0.62cm) and 22.05cm (SD: 0.21cm) for the left and right sides respectively. In four patients who required reconstruction, three flaps survived without problems but one flap developed partial necrosis. CONCLUSIONS Resecting inferior costal cartilage segments or associated muscle can lengthen the pedicle of the rectus abdominis flap for reconstruction of defects on the upper chest and neck.
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Affiliation(s)
- J Q Zhang
- Sun Yat-sen Memorial Hospital , Guangzhou , China
| | - J M Zhang
- Sun Yat-sen Memorial Hospital , Guangzhou , China
| | - W Q Liang
- Sun Yat-sen Memorial Hospital , Guangzhou , China
| | - C Y Ji
- Sun Yat-sen Memorial Hospital , Guangzhou , China
| | - Y H Chen
- Sun Yat-sen Memorial Hospital , Guangzhou , China
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Vieira RADC, da Silva KMT, de Oliveira-Junior I, de Lima MA. 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. J Surg Oncol 2017; 115:949-958. [DOI: 10.1002/jso.24619] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2016] [Accepted: 03/02/2017] [Indexed: 12/15/2022]
Affiliation(s)
- René Aloisio da Costa Vieira
- Postgraduate Program in Oncology, Barretos Cancer Hospital; Pio XII Foundation; Barretos São Paulo Brazil
- Department of Mastology and Breast Reconstruction, Barretos Cancer Hospital; Pio XII Foundation; Barretos São Paulo Brazil
| | - Katia Mathias Teixeira da Silva
- Postgraduate Program in Oncology, Barretos Cancer Hospital; Pio XII Foundation; Barretos São Paulo Brazil
- Department of Mastology and Breast Reconstruction, Barretos Cancer Hospital; Pio XII Foundation; Barretos São Paulo Brazil
| | - Idam de Oliveira-Junior
- Department of Mastology and Breast Reconstruction, Barretos Cancer Hospital; Pio XII Foundation; Barretos São Paulo Brazil
| | - Marcos Alves de Lima
- Center of Epidemiology and Statistics, Barretos Cancer Hospital; Pio XII Foundation; Barretos São Paulo Brazil
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Scaglioni MF, Lindenblatt N, Barth AA, Fuchs B, Weder W, Giovanoli P. Free fillet flap application to cover forequarter or traumatic amputation of an upper extremity: A case report. Microsurgery 2016; 36:700-704. [DOI: 10.1002/micr.30124] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2016] [Revised: 09/21/2016] [Accepted: 09/30/2016] [Indexed: 11/09/2022]
Affiliation(s)
- Mario F. Scaglioni
- Department of Plastic and Hand Surgery; University Hospital Zurich; Switzerland
| | - Nicole Lindenblatt
- Department of Plastic and Hand Surgery; University Hospital Zurich; Switzerland
| | - André A. Barth
- Department of Plastic and Hand Surgery; University Hospital Zurich; Switzerland
| | - Bruno Fuchs
- Balgrist University Hospital, Sarcoma Center-UZH University of Zurich; Switzerland
| | - Walter Weder
- Division of Thoracic Surgery; University Hospital Zurich, University of Zurich; Switzerland
| | - Pietro Giovanoli
- Department of Plastic and Hand Surgery; University Hospital Zurich; Switzerland
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Linhares M, Freitas Í, Gorczak R, Feranti J, Zanetti R, Macagnan M, Schossler J, Brun M. Reparo de lesão penetrante em parede torácica de cão, ocasionada por javali (Sus scrofa scrofa), com flape unipediculado de músculo reto abdominal. ARQ BRAS MED VET ZOO 2016. [DOI: 10.1590/1678-4162-8412] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
RESUMO Lesões penetrantes no tórax causadas por interação animal são frequentes em cães e caracterizam-se por dano extenso e desvitalização dos tecidos moles adjacentes. Quando a musculatura local é insuficiente para a reconstrução, retalhos musculares podem ser mobilizados para reparar o defeito torácico. O presente relato tem como objetivo demonstrar uma alternativa para o reparo de defeito da parede torácica em um cão, ocasionada por interação com javali (Sus scrofa scrofa), utilizando flape unipediculado de músculo reto abdominal. Com base na literatura consultada, essa técnica reconstrutiva ainda não foi descrita. O flape de músculo reto abdominal mostrou-se uma alternativa viável no reparo de lesão extensa e infectada na parede torácica em cães.
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Affiliation(s)
| | | | | | | | | | | | | | - M.V. Brun
- Universidade Federal de Santa Maria, Brazil; CNPq, Brazil
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35
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Momeni A, Kovach SJ. Important considerations in chest wall reconstruction. J Surg Oncol 2016; 113:913-22. [PMID: 26969557 DOI: 10.1002/jso.24216] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2016] [Accepted: 02/16/2016] [Indexed: 12/28/2022]
Abstract
Chest wall reconstruction represents one of the most challenging tasks in plastic surgery. Over the past several decades, a more profound understanding of surgical anatomy and physiology along with tremendous advances in surgical technique have resulted in substantial improvements in postoperative outcomes. Conceptually, the reconstructive goals include dead space obliteration, restoration of skeletal stability with protection of intrathoracic structures, and stable soft tissue coverage. Ideally, these goals are achieved with minimal aesthetic deformity. J. Surg. Oncol. 2016;113:913-922. © 2016 Wiley Periodicals, Inc.
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Affiliation(s)
- Arash Momeni
- Division of Plastic Surgery, University of Pennsylvania Health Systems, Philadelphia, Pennsylvania
| | - Stephen J Kovach
- Division of Plastic Surgery, University of Pennsylvania Health Systems, Philadelphia, Pennsylvania
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Chirappapha P, Lertsithichai P, Sukarayothin T, Leesombatpaiboon M, Supsamutchai C, Kongdan Y. Oncoplastic techniques in breast surgery for special therapeutic problems. Gland Surg 2016; 5:75-82. [PMID: 26855912 DOI: 10.3978/j.issn.2227-684x.2015.05.04] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
Resection of large tumors can be challenging, from the view point of breast preservation. Oncoplastic techniques are a valuable component of breast surgery in patients with large breast tumors who desire breast preservation. These techniques have been shown to be oncologically safe, while maintaining acceptable breast cosmesis. For locally advanced or recurrent breast cancers, the goals of surgery include local disease control and palliation of clinical symptoms. Oncoplastic surgery is also effective and oncologically safe in these situations. The need to completely remove all foci of cancers with adequate surgical margins often requires the displacement of adjacent or distant skin and soft tissue to cover the resulting soft tissue defect. Sometimes doing so can be cosmetically pleasing as well. In this article we present three special therapeutic problems in three distinct conditions, all resolved with oncoplastic techniques: the benign breast condition, malignant breast condition, and the palliative setting.
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Affiliation(s)
- Prakasit Chirappapha
- Department of Surgery, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - Panuwat Lertsithichai
- Department of Surgery, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - Thongchai Sukarayothin
- Department of Surgery, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - Monchai Leesombatpaiboon
- Department of Surgery, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - Chairat Supsamutchai
- Department of Surgery, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - Youwanush Kongdan
- Department of Surgery, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
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Miyamoto S, Fujiki M, Kawai A, Chuman H, Sakuraba M. Anterolateral thigh flap for axillary reconstruction after sarcoma resection. Microsurgery 2015; 36:378-383. [PMID: 26538371 DOI: 10.1002/micr.22529] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2015] [Revised: 09/05/2015] [Accepted: 10/16/2015] [Indexed: 11/08/2022]
Abstract
BACKGROUND Reconstruction of extensive axillary defects after sarcoma resection presents a challenging problem in reconstructive microsurgery. The purpose of this report was to investigate the feasibility of the free anterolateral thigh (ALT) flap for oncologic axillary reconstruction. METHODS The extensive axillary defects in six patients with sarcoma was reconstructed using a free ALT flap. The defect size ranged from 15 × 11 to 28 × 25 cm2 . Five patients had recurrent cases and the ipsilateral latissimus dorsi flap had been already used in three patients. Two patients with a full-thickness defect underwent chest wall reconstruction with the iliotibial tract. RESULTS All flaps survived completely and the wounds healed without complications in all patients. CONCLUSIONS The free ALT flap is an ideal flap for axillary reconstruction after extensive sarcoma resection. It can be tailored to the requirements of the individual's defect and provides durable coverage for the axillary neurovascular bundle and intrathoracic structures. Flap harvesting in the lateral decubitus position enables a two-team approach. © 2015 Wiley Periodicals, Inc. Microsurgery 36:378-383, 2016.
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Affiliation(s)
- Shimpei Miyamoto
- Division of Plastic and Reconstructive Surgery, National Cancer Center Hospital, Tokyo, Japan
| | - Masahide Fujiki
- Division of Plastic and Reconstructive Surgery, National Cancer Center Hospital, Tokyo, Japan
| | - Akira Kawai
- Division of Orthopedic Surgery, National Cancer Center Hospital, Tokyo, Japan
| | - Hirokazu Chuman
- Division of Orthopedic Surgery, National Cancer Center Hospital, Tokyo, Japan
| | - Minoru Sakuraba
- Division of Plastic and Reconstructive Surgery, National Cancer Center Hospital East, Kashiwa, Japan
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Harati K, Kolbenschlag J, Behr B, Goertz O, Hirsch T, Kapalschinski N, Ring A, Lehnhardt M, Daigeler A. Thoracic Wall Reconstruction after Tumor Resection. Front Oncol 2015; 5:247. [PMID: 26579499 PMCID: PMC4625055 DOI: 10.3389/fonc.2015.00247] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2015] [Accepted: 10/16/2015] [Indexed: 12/20/2022] Open
Abstract
Introduction Surgical 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 methods This article is based on a review of the current literature and the evaluation of a patient database. Results Several 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. Discussion In 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.
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Affiliation(s)
- Kamran Harati
- Department of Plastic Surgery, Burn Center, Hand Center, Sarcoma Reference Center, BG-University Hospital Bergmannsheil Bochum , Bochum , Germany
| | - Jonas Kolbenschlag
- Department of Plastic Surgery, Burn Center, Hand Center, Sarcoma Reference Center, BG-University Hospital Bergmannsheil Bochum , Bochum , Germany
| | - Björn Behr
- Department of Plastic Surgery, Burn Center, Hand Center, Sarcoma Reference Center, BG-University Hospital Bergmannsheil Bochum , Bochum , Germany
| | - Ole Goertz
- Department of Plastic Surgery, Burn Center, Hand Center, Sarcoma Reference Center, BG-University Hospital Bergmannsheil Bochum , Bochum , Germany
| | - Tobias Hirsch
- Department of Plastic Surgery, Burn Center, Hand Center, Sarcoma Reference Center, BG-University Hospital Bergmannsheil Bochum , Bochum , Germany
| | - Nicolai Kapalschinski
- Department of Plastic Surgery, Burn Center, Hand Center, Sarcoma Reference Center, BG-University Hospital Bergmannsheil Bochum , Bochum , Germany
| | - Andrej Ring
- Department of Plastic Surgery, Burn Center, Hand Center, Sarcoma Reference Center, BG-University Hospital Bergmannsheil Bochum , Bochum , Germany
| | - Marcus Lehnhardt
- Department of Plastic Surgery, Burn Center, Hand Center, Sarcoma Reference Center, BG-University Hospital Bergmannsheil Bochum , Bochum , Germany
| | - Adrien Daigeler
- Department of Plastic Surgery, Burn Center, Hand Center, Sarcoma Reference Center, BG-University Hospital Bergmannsheil Bochum , Bochum , Germany
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Chest Wall Reconstruction: Evolution Over a Decade and Experience With a Novel Technique for Complex Defects. Ann Plast Surg 2015; 76:231-7. [PMID: 25992971 DOI: 10.1097/sap.0000000000000502] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Chest wall reconstruction (CWR) with biologic matrices has gained popularity over the last decade; however, data on this topic remain sparse. The aim of this study is to review the different methods and materials used for CWR while reviewing and highlighting a novel approach using a biologic inlay and synthetic onlay technique for larger, complex high-risk defects. METHODS A retrospective review was performed of all patients who underwent full thickness chest wall resection and reconstruction during a 10-year period. Patient characteristics, comorbidities, operative data, as well as postoperative wound complications and outcomes were reviewed. Different reconstructive methods and materials were reviewed and compared. RESULTS From December 2003 to January 2014, a total of 81 patients underwent CWR. The indications for resection/reconstruction included oncologic in 49 patients (60.5%), desmoids tumors in 10 (12.3%), bronchopleural fistula in 3 (3.7%), infection in 7 (8.6%), and anatomic deformity in 7 (8.6%) patients. Synthetic and/or acellular dermal matrices (ADM) reconstruction was used in 59 patients (10 biologic, 22 synthetic, and 27 biologic ADM inlay/synthetic onlay combination). On average, 2.5, 3.5, and 3.6 ribs were resected in the biologic, synthetic, and combination group, respectively (P = 0.1). A greater number of patients in the combination group had a history of chemotherapy and/or radiation therapy (P = 0.03) than the synthetic or biologic alone groups. Risk analysis demonstrated an association between the number of ribs resected and postoperative chest wall complications. The incidence of chest wall/wound complications in the synthetic, combination, and biologic groups was 31.8%, 22.2%, and 10%, respectively (P = 0.47). CONCLUSIONS In the largest single institution study comparing the use of different reconstructive materials, including ADM in CWR, the authors demonstrate that a biologic inlay/synthetic onlay may be used effectively for high-risk, large complex defects. Early outcomes with this technique are promising. The authors believe this combination highlights benefits from both materials because the ADM facilitates tissue ingrowth and revascularization, whereas the synthetic component provides structural durability. Additional studies with larger sample sizes are necessary to further explore the benefits of the combination technique to determine if outcomes are better than either material alone when used to reconstruct high-risk wounds after larger resections.
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Reconstruction using a divided latissimus dorsi muscle flap after conventional posterolateral thoracotomy and the effectiveness of indocyanine green-fluorescence angiography to assess intraoperative blood flow. Surg Today 2015; 46:326-34. [DOI: 10.1007/s00595-015-1181-8] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2014] [Accepted: 03/19/2015] [Indexed: 10/23/2022]
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Hernández Escobar F, Pérez Alonso D, Cano García JR, Quevedo Losada S, López Rivero L. Use of Pectus Bars in the Reconstruction of Complex Anterior Chest Wall Defects. Arch Bronconeumol 2015; 52:170-1. [PMID: 25910544 DOI: 10.1016/j.arbres.2015.02.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2014] [Revised: 02/16/2015] [Accepted: 02/17/2015] [Indexed: 11/19/2022]
Affiliation(s)
- Francisco Hernández Escobar
- Servicio de Cirugía Torácica, Hospital Universitario Insular de Las Palmas de Gran Canaria, Las Palmas de Gran Canaria, Las Palmas, España.
| | - David Pérez Alonso
- Servicio de Cirugía Torácica, Hospital Universitario Insular de Las Palmas de Gran Canaria, Las Palmas de Gran Canaria, Las Palmas, España
| | - José Ramón Cano García
- Servicio de Cirugía Torácica, Hospital Universitario Insular de Las Palmas de Gran Canaria, Las Palmas de Gran Canaria, Las Palmas, España
| | - Santiago Quevedo Losada
- Servicio de Cirugía Torácica, Hospital Universitario Insular de Las Palmas de Gran Canaria, Las Palmas de Gran Canaria, Las Palmas, España
| | - Luis López Rivero
- Servicio de Cirugía Torácica, Hospital Universitario Insular de Las Palmas de Gran Canaria, Las Palmas de Gran Canaria, Las Palmas, España
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Endrizzi DP, Shubert DJ, White RR. Scapulothoracic fusion for low-energy intrathoracic scapula dislocation: a report of two cases. J Shoulder Elbow Surg 2015; 24:e91-5. [PMID: 25648968 DOI: 10.1016/j.jse.2014.12.004] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/14/2014] [Revised: 11/18/2014] [Accepted: 12/06/2014] [Indexed: 02/01/2023]
Affiliation(s)
- Donald P Endrizzi
- Department of Surgery, Division of Orthopedics, Maine Medical Center, Portland, ME, USA.
| | | | - Raymond R White
- Department of Surgery, Division of Orthopedic Trauma, Maine Medical Center, Portland, ME, USA
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Lin GQ, Li YQ, Huang LJ, Luo FY, Jiang HH, Luo WJ. Chest wall tumors: Diagnosis, treatment and reconstruction. Exp Ther Med 2015; 9:1807-1812. [PMID: 26136897 DOI: 10.3892/etm.2015.2353] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2014] [Accepted: 01/12/2015] [Indexed: 12/12/2022] Open
Abstract
The aim of the present study was to determine a suitable procedure for the treatment of chest wall neoplasms with less potential risk and an increased rate of survival. Fifty patients with suspected chest wall malignancies were analyzed using various preliminary investigation tools. Whole-chest scanning was performed in all the patients. The patients were subsequently subjected to biopsies for further confirmation of the neoplasm. All such patients were then treated with a surgical approach and radiation therapy, with a follow-up period lasting up to six years. The majority of the patients showed improved survival rates relative to conventional therapies. The survival rates of patients suffering from osteosarcoma (78%) were higher those of patients with rhabdomyosarcoma (73%) and malignant small round cell tumors (64%). The survival and the mortality rates of the patients with synovial sarcoma and fibrosarcoma were the same. This study, which was conducted on a small group of patients, has provided guidance for further studies on tumors of the chest wall, which may, in turn, increase the longevity of affected patients.
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Affiliation(s)
- Guo-Qiang Lin
- Department of Cardiothoracic Surgery, Xiangya Hospital, Central South University, Changsha, Hunan 410008, P.R. China
| | - Ying-Qiu Li
- Faculty of Basic Medicine, Hunan University of Traditional Chinese Medicine, Changsha, Hunan 410008, P.R. China
| | - Ling-Jin Huang
- Department of Cardiothoracic Surgery, Xiangya Hospital, Central South University, Changsha, Hunan 410008, P.R. China
| | - Fan-Yan Luo
- Department of Cardiothoracic Surgery, Xiangya Hospital, Central South University, Changsha, Hunan 410008, P.R. China
| | - Hai-He Jiang
- Department of Cardiothoracic Surgery, Xiangya Hospital, Central South University, Changsha, Hunan 410008, P.R. China
| | - Wan-Jun Luo
- Department of Cardiothoracic Surgery, Xiangya Hospital, Central South University, Changsha, Hunan 410008, P.R. China
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Atashroo DA, Paik KJ, Chung MT, McArdle A, Senarath-Yapa K, Zielins ER, Tevlin R, Duldulao CR, Walmsley GG, Wearda T, Marecic O, Longaker MT, Wan DC. Assessment of viability of human fat injection into nude mice with micro-computed tomography. J Vis Exp 2015:e52217. [PMID: 25590561 DOI: 10.3791/52217] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022] Open
Abstract
Lipotransfer is a vital tool in the surgeon's armamentarium for the treatment of soft tissue deficits of throughout the body. Fat is the ideal soft tissue filler as it is readily available, easily obtained, inexpensive, and inherently biocompatible.(1) However, despite its burgeoning popularity, fat grafting is hampered by unpredictable results and variable graft survival, with published retention rates ranging anywhere from 10-80%. (1-3) To facilitate investigations on fat grafting, we have therefore developed an animal model that allows for real-time analysis of injected fat volume retention. Briefly, a small cut is made in the scalp of a CD-1 nude mouse and 200-400 µl of processed lipoaspirate is placed over the skull. The scalp is chosen as the recipient site because of its absence of native subcutaneous fat, and because of the excellent background contrast provided by the calvarium, which aids in the analysis process. Micro-computed tomography (micro-CT) is used to scan the graft at baseline and every two weeks thereafter. The CT images are reconstructed, and an imaging software is used to quantify graft volumes. Traditionally, techniques to assess fat graft volume have necessitated euthanizing the study animal to provide just a single assessment of graft weight and volume by physical measurement ex vivo. Biochemical and histological comparisons have likewise required the study animal to be euthanized. This described imaging technique offers the advantage of visualizing and objectively quantifying volume at multiple time points after initial grafting without having to sacrifice the study animal. The technique is limited by the size of the graft able to be injected as larger grafts risk skin and fat necrosis. This method has utility for all studies evaluating fat graft viability and volume retention. It is particularly well-suited to providing a visual representation of fat grafts and following changes in volume over time.
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Affiliation(s)
- David A Atashroo
- Hagey Laboratory for Pediatric Regenerative Medicine, Department of Surgery, Plastic and Reconstructive Surgery Division, Stanford University School of Medicine
| | - Kevin J Paik
- Hagey Laboratory for Pediatric Regenerative Medicine, Department of Surgery, Plastic and Reconstructive Surgery Division, Stanford University School of Medicine
| | - Michael T Chung
- Hagey Laboratory for Pediatric Regenerative Medicine, Department of Surgery, Plastic and Reconstructive Surgery Division, Stanford University School of Medicine
| | - Adrian McArdle
- Hagey Laboratory for Pediatric Regenerative Medicine, Department of Surgery, Plastic and Reconstructive Surgery Division, Stanford University School of Medicine
| | - Kshemendra Senarath-Yapa
- Hagey Laboratory for Pediatric Regenerative Medicine, Department of Surgery, Plastic and Reconstructive Surgery Division, Stanford University School of Medicine
| | - Elizabeth R Zielins
- Hagey Laboratory for Pediatric Regenerative Medicine, Department of Surgery, Plastic and Reconstructive Surgery Division, Stanford University School of Medicine
| | - Ruth Tevlin
- Hagey Laboratory for Pediatric Regenerative Medicine, Department of Surgery, Plastic and Reconstructive Surgery Division, Stanford University School of Medicine
| | - Christopher R Duldulao
- Hagey Laboratory for Pediatric Regenerative Medicine, Department of Surgery, Plastic and Reconstructive Surgery Division, Stanford University School of Medicine
| | - Graham G Walmsley
- Hagey Laboratory for Pediatric Regenerative Medicine, Department of Surgery, Plastic and Reconstructive Surgery Division, Stanford University School of Medicine
| | - Taylor Wearda
- Hagey Laboratory for Pediatric Regenerative Medicine, Department of Surgery, Plastic and Reconstructive Surgery Division, Stanford University School of Medicine
| | - Owen Marecic
- Hagey Laboratory for Pediatric Regenerative Medicine, Department of Surgery, Plastic and Reconstructive Surgery Division, Stanford University School of Medicine
| | - Michael T Longaker
- Hagey Laboratory for Pediatric Regenerative Medicine, Department of Surgery, Plastic and Reconstructive Surgery Division, Stanford University School of Medicine; Institute for Stem Cell Biology and Regenerative Medicine, Stanford University School of Medicine
| | - Derrick C Wan
- Hagey Laboratory for Pediatric Regenerative Medicine, Department of Surgery, Plastic and Reconstructive Surgery Division, Stanford University School of Medicine; Institute for Stem Cell Biology and Regenerative Medicine, Stanford University School of Medicine;
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Singla P, Kachare SD, Fitzgerald TL, Zeri RS, Haque E. Reconstruction using a pedicled upper arm fillet flap after excision of a malignant peripheral nerve sheath tumor: A case report. World J Clin Cases 2014; 2:899-902. [PMID: 25516867 PMCID: PMC4266840 DOI: 10.12998/wjcc.v2.i12.899] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/25/2014] [Revised: 08/29/2014] [Accepted: 10/16/2014] [Indexed: 02/05/2023] Open
Abstract
Non-salvageable extremities have been utilized for harvesting fillet flaps as part of the “spare parts” concept in traumatic and oncologic settings. Here we report on the use of a pedicled fillet flap of the upper arm for chest wall reconstruction after excision of a malignant peripheral nerve sheath tumor in a patient with neurofibromatosis. Pedicled flaps as part of the “spare parts” concept provide the advantage of reduced donor-site morbidity, immediate closure, intact vasculature, and adequate soft tissue coverage of large defects. Malignant peripheral nerve sheath tumor is a rare aggressive tumor with a poor prognosis that may result in large defects post resection. Limited data describes the use of pedicled fillet flaps of the upper extremity. We report the use of a pedicled fillet flap of the upper arm as a viable option that can be successfully used for coverage of soft tissue defects of the shoulder and chest wall post complex resections in an oncologic setting.
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Abstract
Reconstruction of large chest wall defects after resection remains a significant undertaking. Obtaining a negative margin is of paramount importance for long-term survival. While reconstructing the chest wall, recreating a stable chest wall with adequate functional capacity and reasonable cosmesis are always the end goals. Morbidity from these procedures is significant, and mortality continues to hover around 5%. With continued advancement in reconstructive techniques and improved perioperative management, these procedures will continue to result in improved outcomes for patients.
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Affiliation(s)
- Daine T Bennett
- Division of Cardiothoracic Surgery, Department of Surgery, University of Colorado Denver, School of Medicine, 12631 East 17th Avenue, MS 302, Aurora, CO 80045, USA
| | - Michael J Weyant
- Section of General Thoracic Surgery, Division of Cardiothoracic Surgery, University of Colorado Denver, School of Medicine, 12631 East 17th Avenue, MS C310, Aurora, CO 80045, USA.
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Lee I, Kang SY, Heo CY, Lee HY, Kim SE. Evaluation of Flap Tissue Viability by F-18 FDG PET/CT. Nucl Med Mol Imaging 2014; 48:241-3. [PMID: 25177384 DOI: 10.1007/s13139-014-0278-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2014] [Revised: 04/19/2014] [Accepted: 04/28/2014] [Indexed: 11/26/2022] Open
Abstract
A 60-year-old man underwent vertical rectus abdominis myocutaneous flap to reconstruct a left lateral chest wall defect. For assessment of viability of muscle flap, F-18 fluoro-2-deoxyglucose (FDG) positron emission tomography/computed tomography (PET/CT) was performed 15 days after surgery. The FDG PET/CT showed a small metabolic defect in the left lateral chest wall. During follow-up, necrotic change of the graft was observed, and the site was in accordance with the area where the metabolic defect was observed in the FDG PET/CT. As a result, debridement and wound closure was performed. This case suggested that the FDG PET/CT should be a useful method for the monitoring of muscle viability after flap surgery.
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Affiliation(s)
- Inki Lee
- Department of Nuclear Medicine, Seoul National University Bundang Hospital, 82, Gumi-Ro 173 Beon-Gil, Bundang-Gu, Seongnam-Si, Gyeonggi-Do 463-707 Korea
| | - Seo Young Kang
- Department of Nuclear Medicine, Seoul National University Bundang Hospital, 82, Gumi-Ro 173 Beon-Gil, Bundang-Gu, Seongnam-Si, Gyeonggi-Do 463-707 Korea
| | - Chan-Yeong Heo
- Department of Plastic Surgery, Seoul National University Bundang Hospital, Seongnam-Si, Korea
| | - Ho-Young Lee
- Department of Nuclear Medicine, Seoul National University Bundang Hospital, 82, Gumi-Ro 173 Beon-Gil, Bundang-Gu, Seongnam-Si, Gyeonggi-Do 463-707 Korea
| | - Sang Eun Kim
- Department of Nuclear Medicine, Seoul National University Bundang Hospital, 82, Gumi-Ro 173 Beon-Gil, Bundang-Gu, Seongnam-Si, Gyeonggi-Do 463-707 Korea
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Jungraithmayr W, Laube I, Hild N, Stark WJ, Mihic-Probst D, Weder W, Buschmann J. Bioactive nanocomposite for chest-wall replacement: Cellular response in a murine model. J Biomater Appl 2013; 29:36-45. [DOI: 10.1177/0885328213513621] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Chest-wall invading malignancies usually necessitate the resection of the respective part of the thoracic wall. Gore-Tex® is the material of choice that is traditionally used to repair thoracic defects. This material is well accepted by the recipient; however, though not rejected, it is an inert material and behaves like a ‘foreign body’ within the thoracic wall. By contrast, there are materials that have the potential to physiologically integrate into the host, and these materials are currently under in vitro and also in vivo investigation. These materials offer a gradual but complete biodegradation over time, and severe adverse inflammatory responses can be avoided. Here, we present a novel material that is a biodegradable nanocomposite based on poly-lactic- co-glycolic acid and amorphous calcium phosphate nanoparticles in comparison to the traditionally employed Gore-Tex® being the standard for chest-wall replacement. On a mouse model of thoracic wall resection, that resembles the technique and localization applied in humans, poly-lactic- co-glycolic acid and amorphous calcium phosphate nanoparticles and Gore-Tex® were implanted subcutaneously and additionally tested in a separate series as a chest-wall graft. After 1, 2, 4 and 8 weeks cell infiltration into the respective materials, inflammatory reactions as well as neo-vascularization (endothelial cells) were determined in six different zones. While Gore-Tex® allowed for cell infiltration only at the outer surface, electrospun poly-lactic- co-glycolic acid and amorphous calcium phosphate nanoparticles were completely penetrated by infiltrating cells. These cells were composed mainly by macrophages, with only 4% of giant cells and lymphocytes. Total macrophage count increased by time while the number of IL1-β–expressing macrophages decreased, indicating a protective state towards the graft. As such, poly-lactic- co-glycolic acid and amorphous calcium phosphate nanoparticles seem to develop ideal characteristics as a material for chest-wall replacement by (a) having the advantage of full biodegradation, (b) displaying stable chest-wall structures and (c) adapting a physiological and integrating graft compared to Gore-Tex®.
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Affiliation(s)
| | - Isabelle Laube
- Division of Thoracic Surgery, University Hospital Zurich, Switzerland
| | - Nora Hild
- Department of Chemistry and Applied Biosciences, Institute for Chemical and Bioengineering, ETH Zurich, Zurich, Switzerland
| | - Wendelin J Stark
- Department of Chemistry and Applied Biosciences, Institute for Chemical and Bioengineering, ETH Zurich, Zurich, Switzerland
| | | | - Walter Weder
- Division of Thoracic Surgery, University Hospital Zurich, Switzerland
| | - Johanna Buschmann
- Division of Plastic and Hand Surgery, University Hospital Zurich, Switzerland
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