title: Microsurgical Reconstruction of Large Oncologic Chest Wall Defects for Locally Advanced Breast Cancer or Osteoradionecrosis: A Retrospective Review of 26 Cases over a 5-Year Period.
abstract: BACKGROUND
  Locally advanced breast cancer (LABC) and chest wall osteoradionecrosis (ORN) often require extensive and composite tissue resection, including muscles, ribs, pleura, and lung parenchyma. As such, these cases necessitate complex reconstructive procedures for skeletal chest wall reconstruction and soft tissue resurfacing of extensive defects. Traditional local and regional flaps are often inadequate, and many such cases are prospectively labeled "unresectable."
  
  
  METHODS
  We report a single-center experience with the microsurgical reconstruction of such defects over a 5-year period. Between 2007 and 2011, 1,077 microvascular reconstructive cases following breast cancer resection were performed, of which 26 cases comprised LABC or ORN requiring reconstruction. Surgical indications, defect parameters, choice of reconstruction, and outcomes were assessed.
  
  
  RESULTS
  Thirty free flap microsurgical reconstructions were undertaken in 26 cases, with a 96.2% flap survival rate. Complications were low, and mean hospital stay was 8.7 days. An algorithmic approach to management is presented.
  
  
  CONCLUSIONS
  Wide resection and microvascular free tissue transfer provide versatile solutions for the reconstruction of extensive chest wall defects. With good reported perioperative outcomes even in advanced cases, surgical resection of LABC may offer a useful approach in difficult and/or palliative cases.
authors: Department of Plastic Surgery, St Andrews Centre for Plastic Surgery, Broomfield, Chelmsford, Essex, United Kingdom.
authors: Reza
authors: R
authors: Arya
authors: Department of Plastic Surgery, St Andrews Centre for Plastic Surgery, Broomfield, Chelmsford, Essex, United Kingdom.
authors: Whitney T
authors: WT
authors: Chow
authors: Department of Plastic Surgery, St Andrews Centre for Plastic Surgery, Broomfield, Chelmsford, Essex, United Kingdom.
authors: Warren Matthew
authors: WM
authors: Rozen
authors: Department of Plastic Surgery, St Andrews Centre for Plastic Surgery, Broomfield, Chelmsford, Essex, United Kingdom.
authors: Nakul G
authors: NG
authors: Patel
authors: Department of Plastic Surgery, St Andrews Centre for Plastic Surgery, Broomfield, Chelmsford, Essex, United Kingdom.
authors: Matthew
authors: M
authors: Griffiths
authors: Department of Cardiothoracic Surgery, Broomfield Hospital, Broomfield, Chelmsford, Essex, United Kingdom.
authors: Samir
authors: S
authors: Shah
authors: Department of Plastic Surgery, St Andrews Centre for Plastic Surgery, Broomfield, Chelmsford, Essex, United Kingdom.
authors: Venkat V
authors: VV
authors: Ramakrishnan
mesh_terms: D000328:Adult; D000714:Anastomosis, Surgical / Q000379:methods; D001943:Breast Neoplasms / Q000150:complications / Q000601:surgery*; D005260:Female; D006801:Humans; D008408:Mastectomy / Q000379:methods*; D008875:Middle Aged; D010025:Osteoradionecrosis / Q000601:surgery*; D019651:Plastic Surgery Procedures / Q000379:methods; D012189:Retrospective Studies; D012272:Ribs / Q000601:surgery*; D013524:Surgical Flaps / Q000098:blood supply; D019616:Thoracic Surgical Procedures / Q000379:methods; D035441:Thoracic Wall / Q000601:surgery*; D006113:United Kingdom / Q000453:epidemiology