Combined laparoscopically harvested omental flap with meshed skin grafts and vacuum-assisted closure for reconstruction of complex chest wall defects.
BACKGROUND
Chest wall reconstruction after radiation damage is a challenge in oncologic and plastic surgery. The defect can be reconstructed with laparoscopically harvested omental flap and meshed skin grafts. Our aim was to evaluate the use of vacuum-assisted closure (V.A.C.) in combination with laparoscopically harvested omental flap and meshed skin graft for treating these complex wounds.


METHODS
Between October 2003 and December 2004, 11 patients underwent a chest wall reconstruction with laparoscopic omentoplasty and V.A.C. treatment of severe chest wall radionecrosis after breast cancer treatment (n = 10) or for locally advanced breast cancer treated first by irradiation (n = 1).


RESULTS
Laparoscopic harvesting was uneventful in 10 cases. One patient had a laparoscopic transverse colic resection because of a middle colic artery injury. Mean time of the laparoscopic procedure was 53 minutes (range: 35-120). Wound surface area averaged 360 cm (range: 80-750). The mean duration of V.A.C. treatment was 9.3 days (range: 6-16). Nine patients showed primary wound healing without adverse events. Complications occurred in 3 patients. One developed a pulmonary infection and died after healing during the postoperative course. One presented a partial flap loss, leading to delayed healing after 45 days. One patient with severe radiation damage and a complete brachial plexus paralysis required a shoulder amputation after an extensive necrosis. All but 1 patient are alive and resumed their normal daily activities.


CONCLUSIONS
Combination of laparoscopic omentoplasty and V.A.C. can successfully be used for reconstruction of complex chest wall radiation damage.
Ferron
Gwenael
G
Department of Surgical Oncology, Institut Claudius Regaud Cancer Center, Toulouse, France. ferron.gwenael@claudiusregaud.fr
Garrido
Ignacio
I
Martel
Pierre
P
Gesson-Paute
Amelie
A
Classe
Jean-Marc
JM
Letourneur
Benoit
B
Querleu
Denis
D
D000038:Abscess / Q000209:etiology / Q000601:surgery; D000368:Aged; D000369:Aged, 80 and over; D001943:Breast Neoplasms / Q000532:radiotherapy* / Q000601:surgery*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D010535:Laparoscopy / Q000379:methods*; D008875:Middle Aged; D009779:Occlusive Dressings; D009852:Omentum; D011183:Postoperative Complications / Q000209:etiology / Q000601:surgery; D011832:Radiation Injuries / Q000601:surgery*; D012086:Reoperation; D016038:Skin Transplantation / Q000379:methods*; D013524:Surgical Flaps; D013526:Surgical Mesh; D013530:Surgical Wound Infection / Q000209:etiology / Q000601:surgery; D035441:Thoracic Wall / Q000528:radiation effects* / Q000601:surgery; D020858:Tissue and Organ Harvesting / Q000379:methods*; D014618:Vacuum; D014945:Wound Healing / Q000502:physiology