title: [A case of chest wall reconstruction with scapular flap and rib autotransplantation for recurrent esophageal cancer].
abstract: Subtotal esophagectomy was carried out for esophageal cancer in a 64-year-old male patient. The postoperative stage was a1, n2, stage III. From around 10 months after surgery, a recurrent tumor of first size was recognized at the right anterior lateral thoracic wall, corresponding to the site of the thoracotomy wound, and the tumor involved the right 4th 5th ribs and the subcutaneous soft tissue including the pectoralis major and latissimus dorsi muscles. Total layer chest wall resection including 3rd to 6th ribs, with the tumor was performed. In order to reconstruct the cutaneous soft tissue, a scapular skin flap with vascular pedicle of the circumflex scapular artery and vein was made. Moreover, for the purpose of reinforcing the osseous thoracic wall, a free autogenous rib was transplanted; namely, the 7th rib was cut in half lengthwise and then fixed like a bridge at the center of the defective site of the thoracic wall. Finally, the region was covered with the scapular skin flap for the chest wall reconstruction. After the surgery, supplemental ventilation was not necessary. Although fracture of the transplanted rib was recognized at month 2, the thorax was stable, even immediately after the surgery. Therefore, this method is considered to be useful for reconstruction after total layer chest wall resection.
authors.affiliation: Department of Surgery, Tokyo Medical College, Japan.
authors.forename: H
authors.initials: H
authors.lastname: Okitsu
authors.forename: O
authors.initials: O
authors.lastname: Koganezawa
authors.forename: M
authors.initials: M
authors.lastname: Moritani
authors.forename: R
authors.initials: R
authors.lastname: Amemiya
authors.forename: K
authors.initials: K
authors.lastname: Kimura
mesh_terms: D004938:Esophageal Neoplasms / Q000473:pathology*; D006801:Humans; D008297:Male; D008875:Middle Aged; D012272:Ribs / Q000637:transplantation*; D013524:Surgical Flaps / Q000379:methods*; D013899:Thoracic Neoplasms / Q000556:secondary / Q000601:surgery*; D013908:Thoracotomy / Q000379:methods*