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Volume 40 Issue 7
Jul.  2024
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Article Navigation >  CHINESE JOURNAL OF BURNS AND WOUNDS  > 2024  >  40(7): 650-656
Yu JY,Song DJ,Liu X,et al.Clinical effects of combined tissue flap transplantation for repairinggiant chest wall defects[J].Chin J Burns Wounds,2024,40(7):650-656.DOI: 10.3760/cma.j.cn501225-20231120-00199.
Citation: Yu JY,Song DJ,Liu X,et al.Clinical effects of combined tissue flap transplantation for repairinggiant chest wall defects[J].Chin J Burns Wounds,2024,40(7):650-656.DOI: 10.3760/cma.j.cn501225-20231120-00199.
shu

Clinical effects of combined tissue flap transplantation for repairinggiant chest wall defects

doi: 10.3760/cma.j.cn501225-20231120-00199
  • 1.

    Department of Breast Oncoplastic Surgery, Hunan Cancer Hospital, Changsha 410008, China

  • 2.

    Ultrasonic Diagnostic Center, Hunan Cancer Hospital, Changsha 410008, China

  • 3.

    Department of Plastic and Reconstructive Surgery, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200011, China

  • 4.

    Department of Breast and Thyroid Surgery, Jiangyin People's Hospital, Jiangyin 214400, China

Funds:

Scientific Research Project of Health Commission of Hunan Province 202209024847

Science and Health Planning Project of Hunan Provincial Natural Science Foundation 2023JJ60334

More Information
  • Corresponding author: Song Dajiang, Email: sdj41@163.com
  • Received Date: 2023-11-20
    Abstract
  •   Objective  To investigate the clinical effects of combined tissue flap transplantation in repairing giant chest wall defects.  Methods  This study was a retrospective observational study. From August 2013 to December 2020, 31 patients with chest wall tumor or radiation ulcer after radical resection of chest wall tumor and conformed to the inclusion criteria were admitted to the Department of Breast Oncoplastic Surgery of Hunan Cancer Hospital, including 12 males and 19 females, aged 25-71 years. After resection of tumor or ulcer and wound debridement, the area of secondary chest wall defect was 300-600 cm2 with length of 16-35 cm and width of 16-32 cm. According to the actual situation of the patients and the preoperative design, the chest wall defects were repaired with the flexible combination of perforator flaps and myocutaneous flaps from different donor sites, and the area of the combined tissue flap was 260-540 cm2 with length of 20-30 cm and width of 13-20 cm. Free posteromedial thigh perforator flap+free anterolateral thigh myocutaneous flap were used in 2 patients, free deep inferior epigastric artery perforator flap+free anterolateral thigh myocutaneous flap were used in 5 patients, free deep inferior epigastric artery perforator flap+pedicled rectus abdominis myocutaneous flap+free anterolateral thigh myocutaneous flap were used in 7 patients, free deep inferior epigastric artery perforator flap+pedicled rectus abdominis myocutaneous flap+pedicled latissimus dorsi myocutaneous flap were used in 2 patients, and bilateral free anterolateral thigh myocutaneous flaps were used in 15 patients. For the remaining small area of superficial tissue defect after being repaired by combined tissue flaps, skin graft was used to repair or delayed local flap transfering was performed after the tissue flaps survived and edema subsided. The appropriate blood vessels in the donor and recipient sites were selected for anastomosis to reconstruct the blood supply of tissue flaps. The wounds in the donor sites of tissue flaps that can be directly sutured were sutured directly; for those that cannot be sutured directly, the skin grafting or delayed suture was performed. The anastomosis of blood vessels in the recipient sites, operation length, and postoperative hospital stay were recorded. The survivals of tissue flaps and skin grafts, the shape and texture of reconstructed chest wall, the wound healing, scar formation, and function of donor sites of tissue flaps, and the scar formation of the donor sites of skin grafts were observed after operation. Tumor recurrence and death of recurrent patients were followed up after operation.  Results  The blood vessels in the recipient sites were anastomosed as follows: proximal internal thoracic vessels for 24 times, distal internal thoracic vessels for 12 times, trunk of thoracodorsal vessels for 4 times, anterior serratus branches of thoracodorsal vessels for 8 times, and thoracoacromial vessels for 12 times. The operation length was 6.0 to 8.5 hours, and the postoperative hospital stay was 9 to 21 days. Necrosis at the edge of partial tissue flaps occurred in 4 patients after operation, which healed after dressing change, and the tissue flaps and skin grafts of the other patients survived completely. The shape and texture of the reconstructed chest wall were good. Four patients had poor wound healing in the donor sites of abdominal tissue flaps, which healed after dressing change and local drainage. Only linear scar was left in the donor sites of all tissue flaps, and there was no obvious dysfunction in the donor sites of tissue flaps. Mild hypertrophic scar was left in the donor sites of skin grafts. During follow-up of 9 to 36 months after operation, 6 patients had tumor recurrence, and the recurrence time was 5 to 20 months after operation. After comprehensive treatment for patients with tumor recurrence, 3 patients died.  Conclusions  Transplantation of combined tissue flaps in repairing the giant chest wall defects can shorten the time of total operation and hospital stay, and avoid multiple operations. After operation, patients had good chest wall appearance, with reduced tumor recurrence in patients with chest wall tumor.

     

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    • References(30)
  • [1]
    SongD,LiuD,PafitanisG,et al.Extensive microsurgical reconstruction of chest wall defects for locally advanced breast cancer: a 10-year single-unit experience[J].Ann Plast Surg,2020,84(3):293-299.DOI: 10.1097/SAP.0000000000002000.
    [2]
    宋达疆,李赞,周晓,等.局部晚期乳腺癌切除术后巨大复杂创面的整形外科修复[J].中华整形外科杂志,2018,34(8):630-635.DOI: 10.3760/cma.j.issn.1009-4598.2018.08.011.
    [3]
    MillerDL,DurdenFL.Chest wall reconstruction utilizing ovine-derived reinforced tissue matrix[J].Ann Thorac Surg,2023,115(5):1266-1272.DOI: 10.1016/j.athoracsur.2021.12.062.
    [4]
    YoshiokaN.Versatility of the latissimus dorsi free flap during the treatment of complex postcraniotomy surgical site infections[J].Plast Reconstr Surg Glob Open,2017,5(6):e1355.DOI: 10.1097/GOX.0000000000001355.
    [5]
    HaratiK,KolbenschlagJ,BehrB,et al.Thoracic wall reconstruction after tumor resection[J].Front Oncol,2015,5:247.DOI: 10.3389/fonc.2015.00247.
    [6]
    CorkumJP,GarveyPB,BaumannDP,et al.Reconstruction of massive chest wall defects: a 20-year experience[J].J Plast Reconstr Aesthet Surg,2020,73(6):1091-1098.DOI: 10.1016/j.bjps.2020.02.010.
    [7]
    VanstraelenS,BainsMS,DycocoJ,et al.Biologic versus synthetic prosthesis for chest wall reconstruction: a matched analysis[J].Eur J Cardiothorac Surg,2023,64(6):ezad348.DOI: 10.1093/ejcts/ezad348.
    [8]
    WangCM,ZhangR,LuoP,et al.Reconstruction of extensive thoracic wall defect using the external oblique myocutaneous flap: an analysis on 20 Chinese patients with locally advanced soft tissue sarcoma[J].J Surg Oncol,2018,117(2):130-136.DOI: 10.1002/jso.24823.
    [9]
    ZhaoZQ,ZhuXQ,ZhuMR,et al.Chest wall reconstruction of male: latissimus dorsi Kiss flap, rectus abdominis flap and titanium-mesh[J].Asian J Surg,2022,45(7):1443-1444.DOI: 10.1016/j.asjsur.2022.02.041.
    [10]
    NaoumGE,SalamaL,HoA,et al.The impact of chest wall boost on reconstruction complications and local control in patients treated for breast cancer[J].Int J Radiat Oncol Biol Phys,2019,105(1):155-164.DOI: 10.1016/j.ijrobp.2019.04.027.
    [11]
    SaloJ,TukiainenEJ.Oncologic resection and reconstruction of the chest wall: a 19-year experience in a single center[J].Plast Reconstr Surg,2018,142(2):536-547.DOI: 10.1097/PRS.0000000000004597.
    [12]
    SongD,LiJ,PafitanisG,et al.Bilateral anterolateral thigh myocutaneous flaps for giant complex chest wall reconstruction[J].Ann Plast Surg,2021,87(3):298-309.DOI: 10.1097/SAP.0000000000002860.
    [13]
    AlsharkawyK,YoussifS,MalahiasM,et al.Acromiothoracic venous supercharge for abdominal-based free flaps in breast and chest wall reconstruction[J].Ann Plast Surg,2023,91(6):734-739.DOI: 10.1097/SAP.0000000000003704.
    [14]
    VanstraelenS,AliB,BainsMS,et al.The contribution of microvascular free flaps and pedicled flaps to successful chest wall surgery[J].J Thorac Cardiovasc Surg,2023,166(4):1262-1272.e2.DOI: 10.1016/j.jtcvs.2023.05.018.
    [15]
    KimWJ,KimWS,KimHK,et al.Reconstruction of small chest wall defects caused by tubercular abscesses using two different flaps[J].Ann Thorac Surg,2018,106(5):e249-e251.DOI: 10.1016/j.athoracsur.2018.04.019.
    [16]
    LinYN,Ou-YangF,HsiehMC,et al.Use of extended pedicled transverse rectus abdominis myocutaneous flap for extensive chest wall defect reconstruction after mastectomy for locally advanced breast cancer[J].Ann Plast Surg,2020,84(1S Suppl 1):S34-39.DOI: 10.1097/SAP.0000000000002188.
    [17]
    KimJ,LeeKT.Microsurgical reconstruction using thoracoacromial vessels as recipients for complicated chest wall defects[J].Microsurgery,2024,44(4):e31164.DOI: 10.1002/micr.31164.
    [18]
    FreyJD,MotoskoCC,MooreK,et al.A novel periareolar approach to chest wall reconstruction using a nipple-areola complex transposition flap[J].Plast Reconstr Surg,2019,144(3):528e-530e.DOI: 10.1097/PRS.0000000000005926.
    [19]
    KhalilHH, KalkatM. Therapeutic mammoplasty and dermal flap: a novel hybrid approach for chest wall reconstruction[J]. Plast Reconstr Surg Glob Open, 2020,8(3):e2593. DOI: 10.1097/GOX.0000000000002593.
    [20]
    OuyangY,XuB,LuanJ,et al.Chest wall reconstruction in male poland syndrome patients with endoscopic-assisted latissimus dorsi muscle flap transfer[J].J Plast Reconstr Aesthet Surg,2021,74(11):3141-3149.DOI: 10.1016/j.bjps.2021.03.117.
    [21]
    MericliAF,MurariuD,NemirS,et al.Soft-tissue reconstruction after composite vertebrectomy and chest wall resection for spinal tumors[J].Plast Reconstr Surg,2020,145(5):1275-1286.DOI: 10.1097/PRS.0000000000006792.
    [22]
    ZhouB,LongY,LiS,et al.Reconstruction of chronic radiation-induced ulcers in the chest wall using free and pedicle flaps[J].Front Surg,2022,9:1010990.DOI: 10.3389/fsurg.2022.1010990.
    [23]
    MarshDJ,ChanaJS.Reconstruction of very large defects: a novel application of the double skin paddle anterolateral thigh flap design provides for primary donor-site closure[J].J Plast Reconstr Aesthet Surg,2010,63(1):120-125.DOI: 10.1016/j.bjps.2008.08.022.
    [24]
    DurganDM,De La Cruz Ku G,ThomasM,et al.Chest wall resection for breast cancer: 21st century Mayo clinic experience[J].J Surg Oncol,2022,126(6):962-969.DOI: 10.1002/jso.27014.
    [25]
    ZhangYX,HayakawaTJ,LevinLS,et al.The economy in autologous tissue transfer: part 1. The kiss flap technique[J].Plast Reconstr Surg,2016,137(3):1018-1030.DOI: 10.1097/01.prs.0000479971.99309.21.
    [26]
    Russell PintoT,MoraH,PeleteiroB,et al.Chest wall perforator flaps for partial breast reconstruction after conservative surgery: prospective analysis of safety and reliability[J].Surg Oncol,2023,51:102015.DOI: 10.1016/j.suronc.2023.102015.
    [27]
    HashemiA,GimenezA,YimN,et al.Anterior chest wall reconstruction after separation of thoraco-omphalopagus conjoined twins with cadaveric rib grafts and omental flap[J].Ann Plast Surg,2023,91(6):753-757.DOI: 10.1097/SAP.0000000000003645.
    [28]
    LeeS, JungY, BaeY. Immediate chest wall reconstruction using an external oblique myocutaneous flap for large skin defects after mastectomy in advanced or recurrent breast cancer patients: a single center experience[J]. J Surg Oncol, 2018,117(2):124-129.DOI: 10.1002/jso.24830.
    [29]
    李鹏程,贾赤宇,李东杰,等.部分去表皮局部皮瓣修复结核性胸壁缺损创面的临床效果[J].中华烧伤杂志,2021,37(12):1110-1115.DOI: 10.3760/cma.j.cn501120-20210929-00337.
    [30]
    陈斓,张伟,谢卫国,等. 扩张髂腹股沟皮瓣游离移植整复大面积烧伤后严重瘢痕挛缩畸形的临床效果[J]. 中华烧伤与创面修复杂志,2022,38(4):321-327. DOI: 10.3760/cma.j.cn501225-20220210-00021.
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