The major malignant tumors found on the chest wall are sarcomas, including osteosarcomas, chondrosarcomas, fibrosarcomas, and hemangiosarcomas. Treatment of cancer, as well as chronic chest wall conditions, require radical surgical excision of the involved tissues. In addition to surgery, chemotherapy plays a role as adjuvant treatment in tumors affecting the chest wall, reducing chances of metastasis and prolonging the disease. The restoration of the chest wall has the main objective to restore the respiratory function, for this, a procedure is necessary that keeps the chest closed and stable. There are many materials used for chest repair, such as autogenous, synthetic, homologous and heterologous tissues. The main objective of this literature review is to address the main malignancies that affect the chest wall, as well as the resources most used to repair the damage caused by aggressive surgery in an attempt to promote greater safety margins.
The reconstruction of large skin defects originated from the excision of large tumors or trauma may require the use of reconstructive techniques given the possibility of there not being enough skin to cover the skin wound in some situations. Axial pattern flaps from the caudal superficial epigastric artery are skin flaps supplied by a large artery and, therefore, have a larger chance of survival. They are the most versatile flaps for closing defects in the caudal part of the body and may be employed to close defects on the lateral abdomen, sacrum, dorsal pelvis, base of the tail, perineum, penile sheath, inguinal region, proximal pelvic member, knee, shin and metatarsal region in cats. This study aimed at reporting 16 cases of repairs of defects originated from tumoral resection and trauma employing axial pattern flaps from the caudal superficial epigastric artery in dogs and cats.
Background: Large skin defects are caused by tumor excision, making appropriate reconstruction and complete healing of the lesion a challenge for surgeons. There are some difficulties in reaching these goals, especially in cases of surgical wound in the limbs, due to the scarce amount of skin and its reduced elasticity, which limit the possibility of flaps when compared to the head, neck, and trunk. This study reports a case of wound closure on the lateral skin in the femoral region of a dog’s pelvic limb via island skin graft associated with the implantation of a nonadherent cellulose acetate mesh and intensive postoperative care.Case: An 8-year-old Rottweiler female dog was attended at Pontifical Catholic University of Paraná’s Veterinary Clinic (CVE), in Curitiba, Paraná, presenting a tumor located laterocaudally to the right stifle joint. After preoperative examinations, the patient underwent tumor surgery; however, two more surgical procedures were required due to suture dehiscence in the region, which resulted in increased wound size. At first, the wound was treated for granulation tissue to be formed. Subsequently, the island skin grafting technique was chosen to close the wound, associated with the implantation of a nonadherent cellulose acetate mesh imbibed with petrolatum emulsion to keep the grafted fragments in place. The mesh was fixed in a simple interrupted suture pattern using 2-0 nylon thread. The lateral regions of the chest and abdomen were chosen as donor skin beds due to their large dimensions, skin elasticity, and ease in defect reconstruction. The fragments were obtained using a 10-mm biopsy punch and scalpel, and the defects were sutured in a simple interrupted pattern using 2-0 nylon thread. The patient remained hospitalized for movement restriction and postoperative monitoring for 72 h, and the bandage remained untouched during this time interval. Thereafter, the patient was discharged and it was recommended to clean the wound with jets of 0.9% saline using a 40 × 12 needle attached to a 20 mL syringe, from a distance of 10 cm from the wound. The dressings were changed every 48 h to maintain minimum contact with the wound; however, still keeping it clean to optimize healing. Fourteen days postoperatively, the sutures as well as the non adherent mesh were removed from the donor beds. The dressing was changed and the lesion was cleaned every 24 h because the fixation between the receptor bed and the implanted tissue was considered good. After approximately 80 days, complete epithelialization of the wound was observed.Discussion: Closing of large skin defects in the limbs is challenging due to the impossibility of using other reconstructive surgery techniques, which have limited use because of the extension of the lesion. However, island skin grafting can be considered despite its slower skin healing process than that of skin flaps. Specific management is required for the successful execution of this technique, and in the present case, the application of the non adherent mesh after island skin grafting helped in the immobilization and better adhesion of the fragments to the receiving bed. Thus, it was demonstrated that in-depth knowledge of reconstructive surgery and the surgeon’s expertise favor the emergence of ideas and more effective techniques that ensure success of the surgical procedure by avoiding complications and improving the patients’ quality of life.
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