Microvascular reconstructions of full-thickness oncological chest wall defects.
OBJECTIVE
To evaluate the suitability of microvascular flaps for the reconstruction of extensive full-thickness defects of the chest wall.


BACKGROUND
Chest wall defects are conventionally reconstructed with pedicular musculocutaneous flaps or the omentum. Sometimes, however, these flaps have already been used, are not reliable due to previous operations or radiotherapy, or are of inadequate size. In such cases, microvascular flaps offer the only option for reconstruction.


METHODS
From 1988 to 2001, 26 patients with full-thickness resections of the chest wall underwent reconstruction with microvascular flaps. There were 8 soft tissue sarcomas, 8 recurrent breast cancers, 5 chondrosarcomas, 2 desmoid tumors, 1 large cell pulmonary cancer metastasis, 1 renal cancer metastasis, and 1 bronchopleural fistula. The surgery comprised 5 extended forequarter amputations, 5 lateral resections, 8 thoracoabdominal resections, and 8 sternal resections. The mean diameter of a resection was 28 cm. The soft tissue defect was reconstructed with 16 tensor fasciae latae, 5 tensor fascia latae combined with rectus femoris, and 3 transversus rectus abdominis myocutaneous flaps. In 2 patients with a forequarter amputation, the remnant forearm was used as the osteomusculocutaneous free flap.


RESULTS
There were no flap losses or perioperative mortality. Four patients needed tracheostomy owing to prolonged respiratory difficulties. The mean survival time for patients with sarcomas was 39 months and for those with recurrent breast cancer 18 months.


CONCLUSIONS
Extensive chest wall resections are possible with acceptable results. In patients with breast cancer, the surgery may offer valuable palliation and in those with sarcomas it can be curative.
Tukiainen
Erkki
E
Department of Plastic Surgery, Helsinki University Hospital, P.O. Box 266, 00029 HUS, Finland. erkki.tukiainen@hus.fi
Popov
Pentscho
P
Asko-Seljavaara
Sirpa
S
D000328:Adult; D000368:Aged; D005260:Female; D006801:Humans; D008297:Male; D008833:Microcirculation; D008875:Middle Aged; D019651:Plastic Surgery Procedures / Q000379:methods*; D012983:Soft Tissue Neoplasms / Q000601:surgery*; D013524:Surgical Flaps; D035441:Thoracic Wall / Q000601:surgery*