Microsurgical Reconstruction of Large Oncologic Chest Wall Defects for Locally Advanced Breast Cancer or Osteoradionecrosis: A Retrospective Review of 26 Cases over a 5-Year Period

Journal of Reconstructive Microsurgery
Reza AryaVenkat V Ramakrishnan

Abstract

Locally advanced breast cancer (LABC) and chest wall osteoradionecrosis (ORN) often require extensive and composite tissue resection, including muscles, ribs, pleura, and lung parenchyma. As such, these cases necessitate complex reconstructive procedures for skeletal chest wall reconstruction and soft tissue resurfacing of extensive defects. Traditional local and regional flaps are often inadequate, and many such cases are prospectively labeled "unresectable." We report a single-center experience with the microsurgical reconstruction of such defects over a 5-year period. Between 2007 and 2011, 1,077 microvascular reconstructive cases following breast cancer resection were performed, of which 26 cases comprised LABC or ORN requiring reconstruction. Surgical indications, defect parameters, choice of reconstruction, and outcomes were assessed. Thirty free flap microsurgical reconstructions were undertaken in 26 cases, with a 96.2% flap survival rate. Complications were low, and mean hospital stay was 8.7 days. An algorithmic approach to management is presented. Wide resection and microvascular free tissue transfer provide versatile solutions for the reconstruction of extensive chest wall defects. With good reported perioperative o...Continue Reading

Citations

Mar 28, 2017·Clinics in Plastic Surgery·Nakul Gamanlal Patel, Venkat Ramakrishnan
May 22, 2018·Annals of Plastic Surgery·Anne-Sophie FlorczakNicolas Bertheuil
Oct 8, 2018·Journal of Surgical Oncology·Liting JinYiping Gong
Mar 13, 2016·Journal of Surgical Oncology·Arash Momeni, Stephen J Kovach

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