[Show abstract][Hide abstract] ABSTRACT: PURPOSE: Muscle flaps can be used to aid in healing of intrathoracic infections
and can be used prophylactically for bronchial stump coverage following
lung resection when there is a high-risk of stump breakdown due to airway tension
or previous radiation. Large series examining intrathoracic muscle flaps
(ITMFs) are lacking in the literature. The purpose of this study was to analyze
the morbidity/mortality of ITMFs and create an algorithm for their use.
METHODS: All patients undergoing ITMF from January 1991 to December
2010 were retrospectively-reviewed. Patients were stratified into two groups
based on infectious or prophylactic indication, and outcomes were compared
between groups. Demographic information pertinent to surgical outcome was
collected in both groups, including age, BMI, diabetes, end-stage renal disease,
smoking status, chemotherapy/radiation, and ASA classification.
RESUTLS: There were 437 consecutive patients (292 males, 145 females)
who underwent 490 ITMFs (353 serratus anterior, 52 latissimus, 37 intercostal,
30 pectoralis major, 7 omentum, 3 rectus abdominis, 8 other). Multiple ITMFs
were used in 44 patients (range 1–5 total flaps).Median agewas 60 years (range
16–91). ITMFs were used for infection in 264 patients (24.1% previouslyirradiated)
and prophylactically in 173 patients (64.9% previously-irradiated).
The rate of complications was significantly higher in the infected group (56.3%,
n=147) vs. prophylactic group (23.3%, n=40) (p<0.0001). In-hospital mortality
was significantly higher in the infected group (14%, n=37) vs. prophylactic group
(5.2%, n=9) (p=0.005; odds-ratio 3.0). In-hospital mortality was significantly
higher in patients having multiple flaps vs. a single flap (20.5% vs. 9.4%)
(p=0.028; odds-ratio 2.5). Median length-of-stay following ITMF was 14 days
(range 1–258) with median ICU length-of-stay of 4 days (range 0–258). Median
follow-up for patients discharged was 12 months (range 0–274).
CONCLUSION: Use of ITMFs in complex intrathoracic conditions can be
lifesaving. However, patients still experience substantial morbidity and mortality.
An algorithm is presented to help guide flap selection.
[Show abstract][Hide abstract] ABSTRACT: Large and life-threatening thoracic cage defects can result from the treatment of traumatic injuries, tumors, infection, congenital anomalies, and radiation injury and require prompt reconstruction to restore respiratory function and soft tissue closure. Important factors for consideration are coverage with healthy tissue to heal a wound, the potential alteration in respiratory mechanics created by large extirpations or nonhealing thoracic wounds, and the need for immediate coverage for vital structures. The choice of technique depends on the size and extent of the defect, its location, and donor site availability with consideration to previous thoracic or abdominal operations. The focus of this article is specifically to describe the use of the pectoralis major, latissimus dorsi, and rectus abdominis muscle flaps for reconstruction of thoracic defects, as these are the workhorse flaps commonly used for chest wall reconstruction.
Full-text · Article · Feb 2011 · Seminars in Plastic Surgery
[Show abstract][Hide abstract] ABSTRACT: The chest wall functions as a protective cage around the vital organs of the body, and significant disruption of its structure can have dire respiratory and circulatory consequences. The past several decades have seen a marked improvement in the management and reconstruction of complex chest wall defects. Widespread acceptance of muscle and musculocutaneous flaps such as the latissimus dorsi, pectoralis major, serratus anterior, and rectus abdominis has led to a sharp decrease in infections and mortality. Successful reconstructions are dependent upon a detailed knowledge of the functional anatomy and blood supply of the chest and the underlying pathophysiology of a particular disease process. This article will provide an overview of key principles and evidence-based approaches to chest wall reconstruction.
Preview · Article · Feb 2011 · Seminars in Plastic Surgery