Multidisciplinary Oncoplastic Approach Reduces Infection in Chest Wall Resection and Reconstruction for Malignant Chest Wall Tumors

Overview

Journal Plast Reconstr Surg Glob Open

Specialty General Surgery

Date 2016 Aug 19

PMID 27536488

Citations 7

Authors

Haitham H Khalil

Marco N Malahias

Balapathiran Balasubramanian

Madava G Djearaman

Babu Naidu

Melvin F Grainger

Maninder Kalkat

Affiliations

Soon will be listed here.

Abstract

Background: Management of complex thoracic defects post tumor extipiration is challenging because of the nature of pathology, the radical approach, and the insertion of prosthetic material required for biomechanical stability. Wound complications pose a significant problem that can have detrimental effect on patient outcome. The authors outline an institutional experience of a multidisciplinary thoracic oncoplastic approach to improve outcomes.

Methods: Prospectively collected data from 71 consecutive patients treated with chest wall resection and reconstruction were analyzed (2009-2015). The demographic data, comorbidities, operative details, and outcomes with special focus on wound infection were recorded. All patients were managed in a multidisciplinary approach to optimize perioperative surgical planning.

Results: Pathology included sarcoma (78%), locally advanced breast cancer (15%), and desmoids (6%), with age ranging from 17 to 82 years (median, 42 years) and preponderance of female patients (n = 44). Chest wall defects were located anterior and anterolateral (77.5%), posterior (8.4%), and apical axillary (10%) with skeletal defect size ranging from 56 to 600 cm(2) (mean, 154 cm(2)). Bony reconstruction was performed using polyprolene mesh, methyl methacrylate prosthesis, and titanium plates. Soft tissue reconstructions depended on size, location, and flap availability and were achieved using regional, distant, and free tissue flaps. The postoperative follow-up ranged from 5 to 70 months (median, 32 months). All flaps survived with good functional and aesthetic outcome, whereas 2 patients experienced surgical site infection (2.8%).

Conclusions: Multidisciplinary thoracic oncoplastic maximizes outcome for patients with large resection of chest wall tumors with reduction in surgical site infection and wound complications particularly in association with rigid skeletal chest wall reconstruction.

Citing Articles

Biologic versus synthetic prosthesis for chest wall reconstruction: a matched analysis.

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

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Preoperative Long-term Therapeutic Subcutaneous Heparin Administration into Abdomen: Possible Cause for Nonobstructive Microvascular Flap Failure.

Rhobaye S, Malahias M, Youssif S, Alsharkawy K, Kalkat M, Khalil H Plast Reconstr Surg Glob Open. 2021; 9(2):e3400.

PMID: 33680653 PMC: 7929683. DOI: 10.1097/GOX.0000000000003400.

Therapeutic Mammoplasty and Dermal Flap: A Novel Hybrid Approach for Chest Wall Reconstruction.

Khalil H, Kalkat M Plast Reconstr Surg Glob Open. 2020; 8(3):e2593.

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Chest Wall Reconstruction with Porcine Acellular Dermal Matrix (Strattice) and Autologous Tissue Transfer for High Risk Patients with Chest Wall Tumors.

Khalil H, Kalkat M, Malahias M, Rhobaye S, Ashour T, Djearaman M Plast Reconstr Surg Glob Open. 2018; 6(5):e1703.

PMID: 29922541 PMC: 5999444. DOI: 10.1097/GOX.0000000000001703.

References

Losken A, Thourani V, Carlson G, Jones G, Culbertson J, MILLER J . A reconstructive algorithm for plastic surgery following extensive chest wall resection. Br J Plast Surg. 2004; 57(4):295-302. DOI: 10.1016/j.bjps.2004.02.004. View

McKenna Jr R, Mountain C, McMurtrey M, Larson D, STILES Q . Current techniques for chest wall reconstruction: expanded possibilities for treatment. Ann Thorac Surg. 1988; 46(5):508-12. DOI: 10.1016/s0003-4975(10)64686-3. View

Malczewski M, Colony L, Cobb L . Latissimus-sparing thoracotomy in the pediatric patient: a valuable asset for thoracic reconstruction. J Pediatr Surg. 1994; 29(3):396-8. DOI: 10.1016/0022-3468(94)90576-2. View

Weyant M, Bains M, Venkatraman E, Downey R, Park B, Flores R . Results of chest wall resection and reconstruction with and without rigid prosthesis. Ann Thorac Surg. 2005; 81(1):279-85. DOI: 10.1016/j.athoracsur.2005.07.001. View

Abolhoda A, Wirth G, Bui T, Milliken J . Harvest technique for pedicled transposition of latissimus dorsi muscle: an old trade revisited. Eur J Cardiothorac Surg. 2008; 33(5):928-30. DOI: 10.1016/j.ejcts.2008.01.040. View

Chapelier A, Macchiarini P, Rietjens M, Lenot B, Margulis A, Petit J . Chest wall reconstruction following resection of large primary malignant tumors. Eur J Cardiothorac Surg. 1994; 8(7):351-6; discussion 357. DOI: 10.1016/1010-7940(94)90028-0. View

Lindford A, Jahkola T, Tukiainen E . Late results following flap reconstruction for chest wall recurrent breast cancer. J Plast Reconstr Aesthet Surg. 2012; 66(2):165-73. DOI: 10.1016/j.bjps.2012.09.027. View

Mansour K, Thourani V, Losken A, Reeves J, Miller Jr J, Carlson G . Chest wall resections and reconstruction: a 25-year experience. Ann Thorac Surg. 2002; 73(6):1720-5; discussion 1725-6. DOI: 10.1016/s0003-4975(02)03527-0. View

Kaplan K, Chopra K, Feiner J, Gastman B . Chest wall reconstruction with strattice in an immunosuppressed patient. Eplasty. 2011; 11:e46. PMC: 3223486. View

10.

Lans T, van der Pol C, Wouters M, Schmitz P, van Geel A . Complications in wound healing after chest wall resection in cancer patients; a multivariate analysis of 220 patients. J Thorac Oncol. 2009; 4(5):639-43. DOI: 10.1097/JTO.0b013e31819d18c9. View

11.

Arnold P, Pairolero P . Chest-wall reconstruction: an account of 500 consecutive patients. Plast Reconstr Surg. 1996; 98(5):804-10. DOI: 10.1097/00006534-199610000-00008. View

12.

Novoa N, Benito P, Jimenez M, de Juan A, Aranda J, Varela G . Reconstruction of chest wall defects after resection of large neoplasms: ten-year experience. Interact Cardiovasc Thorac Surg. 2007; 4(3):250-5. DOI: 10.1510/icvts.2004.103432. View

13.

Berthet J, Solovei L, Tiffet O, Gomez-Caro A, Bommart S, Canaud L . Chest-wall reconstruction in case of infection of the operative site: is there any interest in titanium rib osteosynthesis?. Eur J Cardiothorac Surg. 2013; 44(5):866-74. DOI: 10.1093/ejcts/ezt084. View

14.

Woo E, Tan B, Lim C . Treatment of recalcitrant air leaks: the combined latissimus dorsi-serratus anterior flap. Ann Plast Surg. 2009; 63(2):188-92. DOI: 10.1097/SAP.0b013e31818a6609. View

15.

Gonfiotti A, Santini P, Campanacci D, Innocenti M, Ferrarello S, Caldarella A . Malignant primary chest-wall tumours: techniques of reconstruction and survival. Eur J Cardiothorac Surg. 2010; 38(1):39-45. DOI: 10.1016/j.ejcts.2009.12.046. View

16.

Berthet J, Wihlm J, Canaud L, Joyeux F, Cosma C, Hireche K . The combination of polytetrafluoroethylene mesh and titanium rib implants: an innovative process for reconstructing large full thickness chest wall defects. Eur J Cardiothorac Surg. 2012; 42(3):444-53. DOI: 10.1093/ejcts/ezs028. View

17.

Hameed A, Akhtar S, Naqvi A, Pervaiz Z . Reconstruction of complex chest wall defects by using polypropylene mesh and a pedicled latissimus dorsi flap: a 6-year experience. J Plast Reconstr Aesthet Surg. 2007; 61(6):628-35. DOI: 10.1016/j.bjps.2007.04.011. View

18.

Mahabir R, Butler C . Stabilization of the chest wall: autologous and alloplastic reconstructions. Semin Plast Surg. 2012; 25(1):34-42. PMC: 3140239. DOI: 10.1055/s-0031-1275169. View

19.

Elshiekh M, Lo T, Shipolini A, McCormack D . Does muscle-sparing thoracotomy as opposed to posterolateral thoracotomy result in better recovery?. Interact Cardiovasc Thorac Surg. 2012; 16(1):60-7. PMC: 3523615. DOI: 10.1093/icvts/ivs295. View

20.

Koppert L, van Geel A, Lans T, van der Pol C, Van Coevorden F, Wouters M . Sternal resection for sarcoma, recurrent breast cancer, and radiation-induced necrosis. Ann Thorac Surg. 2010; 90(4):1102-1108.e2. DOI: 10.1016/j.athoracsur.2010.06.044. View