Repair of infected defects of the chest wall by transposition of greater omentum.
Myocutaneous flaps have a firm role in the reconstruction of soft tissue defects. Furthermore the supply of extremely infected defects of the chest wall with involvement of the ribs is problematic, especially in irradiated regions. The use of the omental transposition flap is an alternative to the latissimus dorsi myocutaneous flap in treatment of such a deficiency associated with necrosis of the ribs and uncovered pleura. The authors have used this method successfully on eight patients. The scope of this technique is not confined to the chest wall. It can also be extended to defects of the region of the axilla and other parts of the body. For checking the extension and constitution of the greater omentum pre-operatively a laparoscopy under local anaesthesia is always carried out. All patients seen by the authors experienced primary healing of the omentum and chest wall. After surgical resection of primary or metastatic chest wall malignancies, irradiation is essential or useful in many cases. Risks of this therapy include damage to underlying parenchyma and overlying skin. The overall incidence of chest wall ulceration from radiation therapy for breast and chest wall lesions is about 5%. In most cases, however, the defects are often the product of both radiation and surgical trauma. These generally deep, foul-smelling and infected wounds are an extreme burden for the patient and a challenge for the surgeon. Conservative treatment never results in wound closure.(ABSTRACT TRUNCATED AT 250 WORDS)
Department of Trauma and Reconstructuve Surgery, University Hospital, Hamburg-Eppendorf.
J V
JV
Wening
G
G
Thoma
A
A
Emmermann
C
C
Zornig
D000368:Aged; D005260:Female; D006801:Humans; D008875:Middle Aged; D009852:Omentum / Q000601:surgery*; D011183:Postoperative Complications / Q000601:surgery; D011832:Radiation Injuries / Q000209:etiology / Q000601:surgery*; D011878:Radiotherapy / Q000009:adverse effects; D013524:Surgical Flaps / Q000379:methods*; D013898:Thoracic Injuries / Q000209:etiology / Q000601:surgery*; D013899:Thoracic Neoplasms / Q000532:radiotherapy / Q000601:surgery; D013909:Thorax / Q000473:pathology