title: Indications and Results of Reconstructive Techniques with Flaps Transposition in Patients Requiring Complex Thoracic Surgery: A 12-Year Experience.
abstract: Flap transposition is an infrequent but far from exceptional thoracic surgical procedure. The aim of this retrospective study was to report our experience in a referral unit of general thoracic surgery analyzing the early results after flap transposition.
  
  
  
  We retrospectively analyzed the clinical records, surgical notes, and postoperative results of a cohort of patients who underwent flap transposition in our unit from November 2000 to February 2013.
  
  
  
  Overall, a surgical approach adopting flap reconstruction techniques was performed in 81 patients (54 males, 27 females) with a median age of 62 years (range 20-87). Flap transposition was necessary to reconstruct chest wall after resection for malignancy (27 patients), to repair intrathoracic viscera perforation (15 patients), and to fill residual cavities secondary to pulmonary/pleural infection (39 patients). A pedicle muscle flap was transposed in most of cases (64 pts, 79 %), while in the remaining 17 cases (11 %), an omental flap was used. There were no immediate postoperative complications, while three in-hospital deaths occurred due to respiratory or multiorgan failure. Among patients undergone flap transposition to fill a residual cavity, we observed a recurrent bronchopleural fistula in three patients (7.7 %); such patients were treated by repeat flap transposition (2 cases) and by repeat cavernostomy (1 case).
  
  
  
  Flap transposition may be indicated as part of a multimodal treatment for severely ill patients requiring complex thoracic surgery.
authors.affiliation: Faculté de Médecine, Université Paris Descartes, Paris, France. sonia.gaucher@aphp.fr.|Service de Chirurgie Thoracique, AP-HP, Hôpitaux Universitaires Paris Centre, Hôpital Cochin, Paris, France. sonia.gaucher@aphp.fr.|Service de Chirurgie Générale, Plastique et Ambulatoire, AP-HP, Hôpitaux Universitaires Paris Centre, Hôpital Cochin, 27 Rue du Faubourg Saint-Jacques, 75 014, Paris, France. sonia.gaucher@aphp.fr.
authors.forename: Sonia
authors.initials: S
authors.lastname: Gaucher
authors.affiliation: Unit of Thoracic Surgery, Arcispedale Santa Maria Nuova-IRCCS, Reggio Emilia, Italy.
authors.forename: Filippo
authors.initials: F
authors.lastname: Lococo
authors.affiliation: Service de Radiologie, AP-HP, Hôpitaux Universitaires Paris Centre, Hôpital Cochin, Paris, France.
authors.forename: Claude
authors.initials: C
authors.lastname: Guinet
authors.affiliation: Service de Chirurgie Thoracique, AP-HP, Hôpitaux Universitaires Paris Centre, Hôpital Cochin, Paris, France.
authors.forename: Antonio
authors.initials: A
authors.lastname: Bobbio
authors.affiliation: Service de Chirurgie Thoracique, AP-HP, Hôpitaux Universitaires Paris Centre, Hôpital Cochin, Paris, France.
authors.forename: Pierre
authors.initials: P
authors.lastname: Magdeleinat
authors.affiliation: Département d'Information Médicale, AP-HP, Hôpitaux Universitaires Paris Centre, Hôpital Cochin, Paris, France.
authors.forename: Samir
authors.initials: S
authors.lastname: Bouam
authors.affiliation: Faculté de Médecine, Université Paris Descartes, Paris, France.|Service de Chirurgie Thoracique, AP-HP, Hôpitaux Universitaires Paris Centre, Hôpital Cochin, Paris, France.
authors.forename: Jean-François
authors.initials: JF
authors.lastname: Regnard
authors.affiliation: Faculté de Médecine, Université Paris Descartes, Paris, France.|Service de Chirurgie Thoracique, AP-HP, Hôpitaux Universitaires Paris Centre, Hôpital Cochin, Paris, France.
authors.forename: Marco
authors.initials: M
authors.lastname: Alifano
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001983:Bronchial Fistula / Q000209:etiology*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D018482:Muscle, Skeletal / Q000637:transplantation; D009852:Omentum / Q000637:transplantation; D010995:Pleural Diseases / Q000209:etiology*; D019651:Plastic Surgery Procedures / Q000009:adverse effects / Q000379:methods*; D012008:Recurrence; D016156:Respiratory Tract Fistula / Q000209:etiology*; D012141:Respiratory Tract Infections / Q000601:surgery; D012189:Retrospective Studies; D013524:Surgical Flaps; D000072836:Surgical Wound / Q000601:surgery; D013899:Thoracic Neoplasms / Q000601:surgery*; D019616:Thoracic Surgical Procedures / Q000009:adverse effects; D035441:Thoracic Wall / Q000601:surgery; D016896:Treatment Outcome; D055815:Young Adult
keywords: Bronchopleural fistula; Chest wall resection; Flap transposition; Lung cancer; Pleuropulmonary infection; Thoracostomy