Clinical effects of lobulated supercharged pedicled rectus abdominis myocutaneous flap for repairing huge chest wall wounds

Zhang Xinshan; Yu Junyi; Li Zan; Song Dajiang

doi:10.3760/cma.j.cn501225-20240109-00012

Volume 41 Issue 3

Mar. 2025

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Article Navigation > CHINESE JOURNAL OF BURNS AND WOUNDS > 2025 > 41(3): 251-257

Zhang Y,Han F,He T,et al.Effects and mechanism of hepatocyte growth factor-modified human adipose mesenchymal stem cells on wound healing of full-thickness skin defects in diabetic rats[J].Chin J Burns,2021,37(9):860-868.DOI: 10.3760/cma.j.cn501120-20200626-00329.

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Zhang XS,Yu JY,Li Z,et al.Clinical effects of lobulated supercharged pedicled rectus abdominis myocutaneous flap for repairing huge chest wall wounds[J].Chin J Burns Wounds,2025,41(3):251-257.DOI: 10.3760/cma.j.cn501225-20240109-00012.

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Clinical effects of lobulated supercharged pedicled rectus abdominis myocutaneous flap for repairing huge chest wall wounds

doi: 10.3760/cma.j.cn501225-20240109-00012

1.
Department of Breast, Wuwei Liangzhou Hospital, Wuwei 733000, China
2.
Department of Breast Oncoplastic Surgery, Hunan Cancer Hospital, Changsha 410008, China

Funds:

Hunan Provincial Natural Science Foundation Joint Project for Science and Health 2023JJ60334

Hunan Provincial Natural Science Foundation Joint Project for Medicine and Health 2025JJ80850

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Corresponding author: Song Dajiang, Email: sdj41@163.com
Received Date: 2024-01-09

Abstract

Abstract

Objective To explore the clinical effects of lobulated supercharged pedicled rectus abdominis myocutaneous flap for repairing huge chest wall wounds. Methods This study was a retrospective observational study. From January 2020 to June 2023, 9 patients with huge chest wall wounds remained after extended radical tumor resection, extended tumor resection, or lesion resection and conformed to the inclusion criteria were admitted to Hunan Cancer Hospital, including 3 males and 6 females, aged 31-59 years. The lobulated supercharged pedicled rectus abdominis myocutaneous flap was used to repair the huge chest wall wounds. The area of chest wall skin and soft tissue defects ranged from 19 cm×15 cm to 25 cm×21 cm, and the area of the harvested myocutaneous flap ranged from 25.0 cm×7.5 cm to 32.0 cm×13.0 cm. After repairing the rectus abdominis muscle and its anterior sheath with a polypropylene mesh, the incision in the donor site was directly sutured. The blood supply of the myocutaneous flap and the selection of blood vessels in recipient area for supercharging during the surgery, the survival of the myocutaneous flap and the healing of the donor area incision after the surgery were observed. The appearance and texture of the reconstructed chest wall, the scar formation in the abdominal donor area, and their impacts on function and appearance, and the tumor recurrence and metastasis were followed up. Results The blood supply of the unilateral myocutaneous flap was poor in 7 patients, and that of the bilateral myocutaneous flaps was poor in 2 patients during the surgery. The recipient area vessels selected for supercharging of the myocutaneous flap were the internal thoracic vessels in 7 patients, the thoracodorsal vessels in 2 patients, and the thoracoacromial vessels in 2 patients. All the myocutaneous flaps survived after surgery. The donor area incisions of 7 patients healed smoothly after surgery; 2 patients had partial dehiscence in the incisions due to excessive incision tension, which healed after debridement and suturing. Follow-up for 8 to 12 months showed that the reconstructed chest wall had good appearance and soft texture; only a linear scar remained in the abdominal donor area, which had no obvious impact on abdominal breathing and the abdomen was aesthetically pleasing; no local tumor recurrence was observed; distant metastases occurred in 2 breast cancer patients. Conclusions The lobulated supercharged pedicled rectus abdominis myocutaneous flap can effectively cover huge chest wall wounds, while maximally ensuring the blood supply of the myocutaneous flap to the greatest extent and safeguarding the success of chest wall reconstruction surgery.
- Rectus abdominis,
- Myocutaneous flap,
- Thoracic wall,
- Breast neoplasms,
- Soft tissue neoplasms,
- Wound repair,
- Flap supercharge

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References

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Clinical effects of lobulated supercharged pedicled rectus abdominis myocutaneous flap for repairing huge chest wall wounds

doi: 10.3760/cma.j.cn501225-20240109-00012