Chest Wall Reconstruction after Oncological Resections

Abstract

Most chest wall defects requiring reconstruction result from tumor resection. bone and soft tissue sarcomas and recurrent mammary cancer are the most common tumors. Careful preoperative evaluation, meticulous surgical technique and active postoperative treatment are important. the selection of reconstruction is based on the nature, size and location of the defect as well as on the general health and prognosis of the patient. the goals of the reconstruction are adequate stability, water-and airtight closure of the chest cavity, and acceptable cosmetic appearance. the pedicled muscular or musculocutaneous flaps are usually the first choice for tissue coverage. these include flaps such as latissimus dorsi, vertical or transverse rectus abdominis and pectoralis. in certain cases also the breast flap or omental flap can be used. in selected cases, a free flap reconstruction is indicated if the local options for reconstruction have been used, or if they are unreliable due to earlier scars or radiotherapy. the free flaps to be used for chest wall can be harvested from the thigh (tensor fascia latae flap, anterolateral thigh flap), from the abdomen (transverse rectus abdominis flaps, deep epigastric perforator flaps) or from the chest wall (latissimus dorsi flap and other flaps based on the subscapular artery). sometimes a fillet forearm can be used as a flap to cover a defect after extended forequarter amputation. artificial meshes are commonly used to give stability in the defect and to give a platform for the flap. Methylmethacrylate embedded between the two layers of a mesh, or one or two rib grafts fixed to the mesh, can be used to give additional stability in extensive defects to prevent paradoxical movement.

Reparo de lesão penetrante em parede torácica de cão, ocasionada por javali (Sus scrofa scrofa), com flape unipediculado de músculo reto abdominal

“…Segundo Kulahci et al (2011) e Tukiainen (2013, os retalhos pediculados musculares ou musculocutâneos regionais são a primeira escolha para a cobertura de tecido mole dos defeitos da parede torácica em humanos. Retalhos musculares são capazes de contribuir com circulação adicional para áreas de isquemia provocadas por traumatismo, facilitar o retorno da função, melhorar o aspecto cosmético e reduzir a contaminação e sepse nas feridas (MacPhail, 2014).…”

“…Frente a essas características, na terceira intervenção vislumbrou-se o uso do músculo reto abdominal. Na medicina, os principais flapes musculares ou musculocutâneos selecionados para a reconstrução de defeitos da parede torácica baseiam-se nos músculos grande dorsal, reto abdominal, peitoral, serrátil e oblíquo abdominal externo (Skoracki e Chang, 2006;Tukiainen, 2013). Músculos recrutados como flapes para ocluir defeitos da parede torácica de pequenos animais incluem o grande dorsal, o oblíquo abdominal externo, o transverso abdominal e o diafragma (Orton, 2007;Hunt, 2012).…”

“…Segundo Kulahci et al (2011) e Tukiainen (2013, os retalhos pediculados musculares, ou musculocutâneos regionais, são a primeira escolha para o reparo de defeitos da parede torácica em humanos. Os principais flapes musculares selecionados para a reconstrução de defeitos da parede torácica em humanos baseiam-se nos músculos grande dorsal, reto abdominal, peitoral, serrátil e oblíquo abdominal externo (Skoracki e Chang, 2006;Tukiainen, 2013).…”

Evaluation of Flap Tissue Viability by F-18 FDG PET/CT

“…Musculocutaneous flaps have been the preferred choice for covering chest wall defects [10]. To cover the epigastric, sternal and the anterolateral chest wall, VRAM or transverse rectus abdominis myocutaneous are used [10,11].…”

“…To cover the epigastric, sternal and the anterolateral chest wall, VRAM or transverse rectus abdominis myocutaneous are used [10,11]. A VRAM flap has advantages including sufficient skin and soft tissue supply, low complication and high success rates [11,12].…”