title: Management of chest wall reconstruction after resection for cancer: a retrospective study of 22 consecutive patients.
abstract: OBJECTIVE
  In this study, we report our experience on immediate reconstruction after resection of primary or metastatic chest wall tumors, to restore protective function and elasticity of chest or sternum.
  
  
  METHODS
  Between 2005 and 2009, 22 patients underwent reconstruction using a free or pedicled flap combined, or not, to alloplastic materials (Goretex®) in order to cover full-thickness defects of the chest wall after cancer surgery. Reconstruction was immediate in all cases.
  
  
  RESULTS
  Mean follow-up was 27 months. Of these, 18 patients were alive at the end of the study (81.5%). Eighteen patients had malignant tumors (82%); within these patients, 12 were alive without recurrence at the end of the study (67%). The average size of the chest wall defect was 255 cm². Goretex® Mesh was used in 8 patients. All patients benefited from reconstruction with a flap: pedicled or free latissimus dorsi flap (n = 15), pedicled great omentum (n=3), deep inferior epigastric perforator free flap (n = 3), and parascapular pedicled flap (n=1).
  
  
  CONCLUSIONS
  In this series, we were able to achieve long-term palliation and even cure in some patients by resecting full-thickness chest wall in local primary or recurrence of breast cancer without increasing morbidity. The same process was used successfully in association with adjuvant treatment in other tumors like skin sarcoma. We have followed a surgical algorithm according to the tumor localization and etiology.
authors.affiliation: Department of Plastic Surgery, Graduate school of Medicine, Paris XII university, Henri Mondor Hospital (AP.HP), Surgical Research Center, Creteil, France. romainbosc@free.fr
authors.forename: Romain
authors.initials: R
authors.lastname: Bosc
authors.forename: Christophe
authors.initials: C
authors.lastname: Lepage
authors.forename: Cynthia
authors.initials: C
authors.lastname: Hamou
authors.forename: Nadia
authors.initials: N
authors.lastname: Matar
authors.forename: Marc-David
authors.initials: MD
authors.lastname: Benjoar
authors.forename: Michael
authors.initials: M
authors.lastname: Hivelin
authors.forename: Laurent
authors.initials: L
authors.lastname: Lantieri
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000465:Algorithms; D005260:Female; D006801:Humans; D008297:Male; D008545:Melanoma / Q000601:surgery; D008875:Middle Aged; D011183:Postoperative Complications / Q000453:epidemiology; D019651:Plastic Surgery Procedures / Q000379:methods*; D012189:Retrospective Studies; D012509:Sarcoma / Q000601:surgery; D012878:Skin Neoplasms / Q000601:surgery; D013524:Surgical Flaps; D013526:Surgical Mesh; D013899:Thoracic Neoplasms / Q000601:surgery*; D019616:Thoracic Surgical Procedures / Q000295:instrumentation / Q000379:methods*; D035441:Thoracic Wall / Q000293:injuries / Q000601:surgery*; D016896:Treatment Outcome