title: A Twelve-Year Consecutive Case Experience in Thoracic Reconstruction.
abstract: BACKGROUND
  We describe the second largest contemporary series of flaps used in thoracic reconstruction.
  
  
  METHODS
  A retrospective review of patients undergoing thoracomyoplasty from 2001 to 2013 was conducted. Ninety-one consecutive patients were identified.
  
  
  RESULTS
  Thoracomyoplasty was performed for 67 patients with intrathoracic indications and 24 patients with chest wall defects. Malignancy and infection were the most common indications for reconstruction (P < 0.01). The latissimus dorsi (LD), pectoralis major, and serratus anterior muscle flaps remained the workhorses of reconstruction (LD and pectoralis major: 64% flaps in chest wall reconstruction; LD and serratus anterior: 85% of flaps in intrathoracic indication). Only 12% of patients required mesh. Only 6% of patients with <2 ribs resected required mesh when compared with 24% with 3-4 ribs, and 100% with 5 or more ribs resected (P < 0.01). Increased rib resections required in chest wall reconstruction resulted in a longer hospital stay (P < 0.01). Total comorbidities and complications were related to length of stay only in intrathoracic indication (P < 0.01). Average intubation time was significantly higher in patients undergoing intrathoracic indication (5.51 days) than chest wall reconstruction (0.04 days), P < 0.05. Average hospital stay was significantly higher in patients undergoing intrathoracic indication (23 days) than chest wall reconstruction (12 days), P < 0.05. One-year survival was most poor for intrathoracic indication (59%) versus chest wall reconstruction (83%), P = 0.0048.
  
  
  CONCLUSIONS
  Thoracic reconstruction remains a safe and successful intervention that reliably treats complex and challenging problems, allowing more complex thoracic surgery problems to be salvaged.
authors.affiliation: Division of Plastic and Reconstructive Surgery, University of Wisconsin School of Medicine and Public Health, Madison, Wis; Maine Medical Center, Cardiothoracic Surgery, Portland, Maine; and Division of Thoracic Surgery, University of Wisconsin School of Medicine and Public Health, Madison, Wis.
authors.forename: Jenny T
authors.initials: JT
authors.lastname: Chen
authors.affiliation: Division of Plastic and Reconstructive Surgery, University of Wisconsin School of Medicine and Public Health, Madison, Wis; Maine Medical Center, Cardiothoracic Surgery, Portland, Maine; and Division of Thoracic Surgery, University of Wisconsin School of Medicine and Public Health, Madison, Wis.
authors.forename: Laura A
authors.initials: LA
authors.lastname: Bonneau
authors.affiliation: Division of Plastic and Reconstructive Surgery, University of Wisconsin School of Medicine and Public Health, Madison, Wis; Maine Medical Center, Cardiothoracic Surgery, Portland, Maine; and Division of Thoracic Surgery, University of Wisconsin School of Medicine and Public Health, Madison, Wis.
authors.forename: Tracey L
authors.initials: TL
authors.lastname: Weigel
authors.affiliation: Division of Plastic and Reconstructive Surgery, University of Wisconsin School of Medicine and Public Health, Madison, Wis; Maine Medical Center, Cardiothoracic Surgery, Portland, Maine; and Division of Thoracic Surgery, University of Wisconsin School of Medicine and Public Health, Madison, Wis.
authors.forename: James D
authors.initials: JD
authors.lastname: Maloney
authors.affiliation: Division of Plastic and Reconstructive Surgery, University of Wisconsin School of Medicine and Public Health, Madison, Wis; Maine Medical Center, Cardiothoracic Surgery, Portland, Maine; and Division of Thoracic Surgery, University of Wisconsin School of Medicine and Public Health, Madison, Wis.
authors.forename: Francisco
authors.initials: F
authors.lastname: Castro
authors.affiliation: Division of Plastic and Reconstructive Surgery, University of Wisconsin School of Medicine and Public Health, Madison, Wis; Maine Medical Center, Cardiothoracic Surgery, Portland, Maine; and Division of Thoracic Surgery, University of Wisconsin School of Medicine and Public Health, Madison, Wis.
authors.forename: Nikita
authors.initials: N
authors.lastname: Shulzhenko
authors.affiliation: Division of Plastic and Reconstructive Surgery, University of Wisconsin School of Medicine and Public Health, Madison, Wis; Maine Medical Center, Cardiothoracic Surgery, Portland, Maine; and Division of Thoracic Surgery, University of Wisconsin School of Medicine and Public Health, Madison, Wis.
authors.forename: Michael L
authors.initials: ML
authors.lastname: Bentz