The contribution of microvascular free flaps and pedicled flaps to successful chest wall surgery

Vanstraelen, Stijn; Barkat, Amina; Bains, Manjit S.; Shahzad, Farooq; Allen, Robert J.; Matros, Evan; Dycoco, Joseph; Adusumilli, Prasad S.; Bott, Matthew; Downey, Robert J.; Huang, James; Isbell, James M.; Molena, Daniela; Park, Bernard J.; Rusch, Valerie W.; Sihag, Smita; Cordeiro, Peter G.; Coriddi, Michelle; Dayan, Joseph H.; Disa, Joseph J.; McCarthy, Colleen M.; Nelson, Jonas A.; Stern, Carrie S.; Mehrara, Babak J.; Jones, David R.; Rocco, Gaetano

doi:10.1016/j.jtcvs.2023.05.018

Cited by 4 publications

(4 citation statements)

References 41 publications

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“…A study of 171 oral cavity cancer patients showed that, whereas the donor site complication rate was significantly higher with a free flap (34.2%) than with a pedicled flap (11.2%), the rate at the recipient site was no different ( 13 ). Another study of 133 flap reconstructions of full-thickness chest wall defects showed that postoperative complications were not significantly different between free ( n = 28) and pedicled flaps ( n = 105) ( 14 ). Pedicled flaps generally offer specific advantages, such as reliability, technical simplicity, shorter operative time, and reduced risk of vascular compromise, making them a valuable tool in chest wall reconstruction post-resection compared with free flaps.…”

Section: Discussionmentioning

confidence: 99%

Pedicled flap transfer after chest wall malignant tumor resection and potential risk of postoperative respiratory problems for patients with low FEV1.0%

Asanuma,

Tsujii,

Hagi

et al. 2024

Front. Surg.

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IntroductionMusculoskeletal transfer for chest wall tissue defects is a crucial method, and pedicled flaps around the chest wall are preferred in terms of location and simplicity of transfer. These require special care because of complications such as partial necrosis, fistula, wound dehiscence, infection, hematoma and restricted function of the arm or shoulder. However, studies of respiratory function are rare. In the present study, we investigated the complications including respiratory problems after wide resection for malignant chest wall tumors with musculoskeletal pedicle transfer.MethodsA total of 13 patients (15 operations) who underwent wide resection of primary, recurrent, or metastatic malignant chest wall tumors and musculoskeletal pedicle transfer for coverage of tissue defects were enrolled in the present study. A retrospective review of all patients was performed using data collected from hospital records and follow-up information. The complications of musculoskeletal transfer after chest wall wide resection, including respiratory problems, are evaluated.ResultsRib or sternal resection was performed in 12 operations, and only soft tissue resection was performed in 3 operations. Latissimus dorsi (LD) pedicle transfer was performed in 13 operations, and pectoralis major (PM) pedicle transfer was performed in 2 operations; basically, wounds were closed primarily. Surgical complications were observed following 5 of the 15 operations (33.3%). Respiratory complications were seen in 7 of the 15 operations (46.7%). Patients with respiratory complications showed significantly lower preoperative FEV1.0% values than those without respiratory complications (p = 0.0196). Skin resection area tended to be higher in the complication group than in the no complication group (p = 0.104).DiscussionPedicled myocutaneous flap transfers such as LD, PM, and rectus abdominus can be used following multiple resections. After harvesting LD or PM, the wound can be closed primarily for an 8–10-cm skin defect in patients with normal respiratory function. However, for patients with low FEV1.0%, after primary closure of LD or PM transfer for wide soft tissue defects, attention should be paid to postoperative respiratory complications.

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Section: Discussionmentioning

confidence: 99%

Pedicled flap transfer after chest wall malignant tumor resection and potential risk of postoperative respiratory problems for patients with low FEV1.0%

Asanuma,

Tsujii,

Hagi

et al. 2024

Front. Surg.

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“…Extensive research in chest reconstruction has explored locoregional and free flaps options (Salo & Tukiainen, 2018; Vanstraelen et al, 2023), and proposed algorithms to guide the selection of these options (Bosc et al, 2011; Isaac et al, 2022; Sauerbier et al, 2011). Muscle flaps are typically favored, although omental flaps can also be utilized if feasible.…”

Section: Discussionmentioning

confidence: 99%

“…Consequently, the feasibility of using such flaps may be compromised, necessitating the exploration of alternative reconstructive approaches (Bosc et al, 2011; Isaac et al, 2022). In such challenging situations, free flap reconstruction has emerged as a potential solution, achieving effective soft tissue coverage in chest wall reconstruction (Seder & Rocco, 2016; Vanstraelen et al, 2023). The success of free‐flap reconstruction depends heavily on the availability of suitable recipient vessels.…”

Section: Introductionmentioning

confidence: 99%

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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“…These circumstances will often demand microvascular techniques. 10 The first scenario is for tumors located in the lower back. In this area, the options for soft tissue coverage are less certain and may involve perforator flaps or microvascular free flap coverage utilizing vein grafts or perforator-to-perforator anastomoses.…”

Section: Reconstruction Of Chest Wall Defects In Resource-constrained...mentioning

confidence: 99%

Reconstruction of Chest Wall Defects in Resource-Constrained Settings

Berlin,

Momoh

2024

Ann Surg Oncol

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The contribution of microvascular free flaps and pedicled flaps to successful chest wall surgery

Cited by 4 publications

References 41 publications

Pedicled flap transfer after chest wall malignant tumor resection and potential risk of postoperative respiratory problems for patients with low FEV1.0%

Pedicled flap transfer after chest wall malignant tumor resection and potential risk of postoperative respiratory problems for patients with low FEV1.0%

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

Reconstruction of Chest Wall Defects in Resource-Constrained Settings

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