Reconstruction of a massive chest wall defect using a free anterolateral–lower medial thigh flaps: a case report

Sim, N.; Ngaserin, Sabrina; Feng, Jia Jun; Kok, Yee Onn; Chua, Hui Wen; Gaviria-Pinzon, Jorge; Chew, Khong Yik; Wong, Allen Wei-Jiat

doi:10.1093/jscr/rjad264

Cited by 2 publications

(1 citation statement)

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“…Also, harvesting the DIEP flap increased the size of the defect. Other options such as a latissimus dorsi flap with an additional free flap from a distant area may have enabled the advancement of surrounding tissues and reduced the size of defect, as done in previous studies [7]. Meticulous preoperative planning should be done, including the size, length, location of recipient vessels, and the need for vessel graft, before selecting a donor tissue.…”

Section: Discussionmentioning

confidence: 99%

Surgical treatment of extensive and multiple skin cancers via excision and reconstruction using multiple flaps: a case report

Lee,

Lee

2024

Arch Hand Microsurg

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A 47-year-old male patient presented with multiple squamous and basal cell carcinomas on the anterior chest, back, and left cheek. The patient experienced odorous discharge from the tumors. Surgical excision was planned, beginning with the anterior chest squamous cell carcinoma. An extensive 32×30 cm cutaneous defect was created, which was covered by a bilateral deep inferior epigastric perforator and pedicled latissimus dorsi myocutaneous flaps. The basal cell carcinomas on the back and squamous cell carcinoma on the left cheek were serially excised, after which the left cheek wound required flap coverage. Postoperative complications such as venous thrombosis and infection led to several reoperations, yet the extensive defect was successfully reconstructed. No local recurrence developed during 31 months of follow-up. We report this case to demonstrate that although the wide excision of very large skin cancers may result in extensive and challenging defects as large as 5.8% of the total body surface area, coverage with appropriate flaps may lead to successful oncologic outcomes and improve the patient’s quality of life.

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Section: Discussionmentioning

confidence: 99%

Surgical treatment of extensive and multiple skin cancers via excision and reconstruction using multiple flaps: a case report

Lee,

Lee

2024

Arch Hand Microsurg

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Microsurgical reconstruction using thoracoacromial vessels as recipients for complicated chest wall defects

Kim,

Lee

2024

Microsurgery

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BackgroundFree tissue transfer is often required for the reconstruction of complex and deep anterior chest wall wounds, for which the identification of suitable recipient vessels is crucial. Although the internal mammary arteries (IMAs) are a representative option, identifying secondary options when these vessels are compromised remains a challenge. This report evaluated the efficacy of using the thoracoacromial vessels (TAVs) as recipients for chest wall reconstruction by reviewing our experience.MethodsWe conducted a retrospective review of patients undergoing free‐flap‐based chest wall reconstruction using TAVs as recipient vessels from February 2020 to March 2023. Patient demographics and surgery‐related characteristics data were collected. The primary outcome of interest was the occurrence of flap perfusion‐related complications.ResultsIn total, 12 cases utilized TAVs as recipients, primarily for defects following sternotomy, where bilateral IMA was unavailable due to prior surgery. The TAVs with reliable perfusion were consistently identified beneath the pectoralis major muscle. The anterolateral thigh flap was predominantly employed, with musculocutaneous or chimeric flaps introduced for bony defects. The mean pedicle length of the harvested flap was 7.2 cm (range, 3–13), and in cases with a vascular gap, the pedicle was extended using an arteriovenous interposition graft. This resulted in a mean pedicle length needed to reach recipient vessels of 9.9 cm (range, 6.5–19). All flaps survived, with only one experiencing partial necrosis.ConclusionsThe TAV could be considered as an attractive alternative recipient vessel in microsurgical reconstruction of complicated chest wall defects when the use of IMA is not feasible.

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Reconstruction of a massive chest wall defect using a free anterolateral–lower medial thigh flaps: a case report

Cited by 2 publications

References 10 publications

Surgical treatment of extensive and multiple skin cancers via excision and reconstruction using multiple flaps: a case report

Surgical treatment of extensive and multiple skin cancers via excision and reconstruction using multiple flaps: a case report

Microsurgical reconstruction using thoracoacromial vessels as recipients for complicated chest wall defects

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