Application of expanded anterolateral thigh myocutaneous flap in the repair of huge chest wall defect_Chinese Journal of Reparative and Reconstructive Surgery

Authors：

SONG Dajiang ¹ ,  LI Zan ¹ , ZHANG Yixin ² , ZHOU Bo ¹ , LÜ Chunliu ¹ , TANG Yuanyuan ¹ , YI Liang ¹ , LUO Zhenhua ¹

1. Department of Oncology Plastic Surgery, Hunan Province Cancer Hospital, Changsha Hunan, 410008, P. R. China;
2. Department of Plastic and Reconstructive Surgery, Shanghai Ninth People’s Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 200011, P. R. China;

Corresponding author：

LI Zan, Email: zzanli@163.com

Keywords：

Anterolateral thigh myocutaneous flap; lateral circumflex femoral artery; chest wall reconstruction

DOI：

10.7507/1002-1892.202202001

Video：

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Objective To investigate the application of expanded anterolateral thigh myocutaneous flap in the repair of huge chest wall defect. Methods Between August 2018 and December 2020, 12 patients, including 4 males and 8 females, were treated with expanded anterolateral thigh myocutaneous flap to repair huge complex defects after thoracic wall tumor surgery. The age ranged from 28 to 72 years, with an average of 54.9 years. There were 4 cases of phyllodes cell sarcoma, 2 cases of soft tissue sarcoma, 1 case of metastatic chest wall tumor of lung cancer, and 5 cases of breast cancer recurrence. All cases underwent 2-7 tumor resection operations, of which 3 cases had previously received lower abdominal flap transplantation and total flap failure occurred, the other 9 cases were thin and were not suitable to use the abdomen as the flap donor site. After thorough debridement, the area of secondary chest wall defect was 300-600 cm²; the length of the flap was (24.7±0.7) cm, the width of the skin island was (10.6±0.7) cm, the length of the lateral femoral muscular flap was (26.8±0.5) cm, the width was (15.3±0.6) cm, and the length of the vascular pedicle was (7.9±0.6) cm. Results The myocutaneous flaps and the skin grafts on the muscular flaps were all survived in 11 patients, and the wounds in the donor and recipient sites healed by first intention. One male patient had a dehiscence of the chest wall incision, which was further repaired by omentum combined with skin graft. The appearance of the reconstructed chest wall in 12 patients was good, the texture was satisfactory, and there was no skin flap contracture and deformation. Only linear scar was left in the donor site of the flap, and slight hyperplastic scar was left in the skin harvesting site, which had no significant effect on the function of the thigh. All patients were followed up 9-15 months, with an average of 12.6 months. No tumor recurrence was found. Conclusion The expanded anterolateral thigh myocutaneous flap surgery is easy to operate, the effective repair area is significantly increased, and multiple flap transplantation is avoided. It can be used as a rescue means for the repair of huge chest wall defects.

Citation： SONG Dajiang, LI Zan, ZHANG Yixin, ZHOU Bo, LÜ Chunliu, TANG Yuanyuan, YI Liang, LUO Zhenhua. Application of expanded anterolateral thigh myocutaneous flap in the repair of huge chest wall defect. Chinese Journal of Reparative and Reconstructive Surgery, 2022, 36(7): 834-839. doi: 10.7507/1002-1892.202202001 Copy

1.	Saint-Cyr M, Schaverien M, Wong C, et al. The extended anterolateral thigh flap: anatomical basis and clinical experience. Plast Reconstr Surg, 2009, 123(4): 1245-1255.
2.	Marsh DJ, Chana JS. Reconstruction of very large defects: a novel application of the double skin paddle anterolateral thigh flap design provides for primary donor-site closure. J Plast Reconstr Aesthet Surg, 2010, 63(1): 120-125.
3.	Song D, Liu D, Pafitanis G, et al. Extensive microsurgical reconstruction of chest wall defects for locally advanced breast cancer: A 10-year single-unit experience. Ann Plast Surg, 2020, 84(3): 293-299.
4.	Song D, Li J, Pafitanis G, et al. Bilateral anterolateral thigh myocutaneous flaps for giant complex chest wall reconstruction. Ann Plast Surg, 2021, 87(3): 298-309.
5.	宋达疆, 李赞, 周晓, 等. 局部晚期乳腺癌切除术后巨大复杂创面的整形外科修复. 中华整形外科杂志, 2018, 34(8): 630-635.
6.	Wei FC, Jain V, Celik N, et al. Have we found an ideal soft-tissue flap? An experience with 672 anterolateral thigh flaps. Plast Reconstr Surg, 2002, 109(7): 2219-2226.
7.	Kuo YR, Seng-Feng J, Kuo FM, et al. Versatility of the free anterolateral thigh flap for reconstruction of soft-tissue defects: review of 140 cases. Ann Plast Surg, 2002, 48(2): 161-166.
8.	Koshima I, Yamamoto H, Hosoda M, et al. Free combined composite flaps using the lateral circumflex femoral system for repair of massive defects of the head and neck regions: an introduction to the chimeric flap principle. Plast Reconstr Surg, 1993, 92(3): 411-420.
9.	Koshima I, Fukuda H, Yamamoto H, et al. Free anterolateral thigh flaps for reconstruction of head and neck defects. Plast Reconstr Surg, 1993, 92(3): 421-430.
10.	Cordeiro PG, Santamaria E, Hidalgo D. The role of microsurgery in reconstruction of oncologic chest wall defects. Plast Reconstr Surg, 2001, 108(7): 1924-1930.
11.	Gore SM, Akhavani MA, Kang N, et al. Chest wall reconstruction using a turbocharged chimaeric anterolateral thigh flap. J Plast Reconstr Aesthet Surg, 2008, 61(4): 438-441.
12.	Larson DL, McMurtrey MJ. Musculocutaneous flap reconstruction of chest-wall defects: an experience with 50 patients. Plast Reconstr Surg, 1984, 73(5): 734-740.
13.	Losken A, Thourani VH, Carlson GW, et al. A reconstructive algorithm for plastic surgery following extensive chest wall resection. Br J Plast Surg, 2004, 57(4): 295-302.
14.	Chang RR, Mehrara BJ, Hu QY, et al. Reconstruction of complex oncologic chest wall defects: a 10-year experience. Ann Plast Surg, 2004, 52(5): 471-479.
15.	Tukiainen E, Popov P, Asko-Seljavaara S. Microvascular reconstructions of full-thickness oncological chest wall defects. Ann Surg, 2003, 238(6): 794-801.
16.	Celik N, Wei FC, Lin CH, et al. Technique and strategy in anterolateral thigh perforator flap surgery, based on an analysis of 15 complete and partial failures in 439 cases. Plast Reconstr Surg, 2002, 109(7): 2211-2216.
17.	Wong CH, Wei FC, Fu B, et al. Alternative vascular pedicle of the anterolateral thigh flap: the oblique branch of the lateral circumflex femoral artery. Plast Reconstr Surg, 2009, 123(2): 571-577.
18.	Netscher DT, Baumholtz MA. Chest reconstruction: Ⅰ. Anterior and anterolateral chest wall and wounds affecting respiratory function. Plast Reconstr Surg, 2009, 124(5): 240e-252e.
19.	Netscher DT, Valkov PL. Reconstruction of oncologic torso defects: emphasis on microvascular reconstruction. Semin Surg Oncol, 2000, 19(3): 255-263.
20.	Friedel G, Kuipers T, Dippon J, et al. Full-thickness resection with myocutaneous flap reconstruction for locally recurrent breast cancer. Ann Thorac Surg, 2008, 85(6): 1894-1900.

1. Saint-Cyr M, Schaverien M, Wong C, et al. The extended anterolateral thigh flap: anatomical basis and clinical experience. Plast Reconstr Surg, 2009, 123(4): 1245-1255.
2. Marsh DJ, Chana JS. Reconstruction of very large defects: a novel application of the double skin paddle anterolateral thigh flap design provides for primary donor-site closure. J Plast Reconstr Aesthet Surg, 2010, 63(1): 120-125.
3. Song D, Liu D, Pafitanis G, et al. Extensive microsurgical reconstruction of chest wall defects for locally advanced breast cancer: A 10-year single-unit experience. Ann Plast Surg, 2020, 84(3): 293-299.
4. Song D, Li J, Pafitanis G, et al. Bilateral anterolateral thigh myocutaneous flaps for giant complex chest wall reconstruction. Ann Plast Surg, 2021, 87(3): 298-309.
5. 宋达疆, 李赞, 周晓, 等. 局部晚期乳腺癌切除术后巨大复杂创面的整形外科修复. 中华整形外科杂志, 2018, 34(8): 630-635.
6. Wei FC, Jain V, Celik N, et al. Have we found an ideal soft-tissue flap? An experience with 672 anterolateral thigh flaps. Plast Reconstr Surg, 2002, 109(7): 2219-2226.
7. Kuo YR, Seng-Feng J, Kuo FM, et al. Versatility of the free anterolateral thigh flap for reconstruction of soft-tissue defects: review of 140 cases. Ann Plast Surg, 2002, 48(2): 161-166.
8. Koshima I, Yamamoto H, Hosoda M, et al. Free combined composite flaps using the lateral circumflex femoral system for repair of massive defects of the head and neck regions: an introduction to the chimeric flap principle. Plast Reconstr Surg, 1993, 92(3): 411-420.
9. Koshima I, Fukuda H, Yamamoto H, et al. Free anterolateral thigh flaps for reconstruction of head and neck defects. Plast Reconstr Surg, 1993, 92(3): 421-430.
10. Cordeiro PG, Santamaria E, Hidalgo D. The role of microsurgery in reconstruction of oncologic chest wall defects. Plast Reconstr Surg, 2001, 108(7): 1924-1930.
11. Gore SM, Akhavani MA, Kang N, et al. Chest wall reconstruction using a turbocharged chimaeric anterolateral thigh flap. J Plast Reconstr Aesthet Surg, 2008, 61(4): 438-441.
12. Larson DL, McMurtrey MJ. Musculocutaneous flap reconstruction of chest-wall defects: an experience with 50 patients. Plast Reconstr Surg, 1984, 73(5): 734-740.
13. Losken A, Thourani VH, Carlson GW, et al. A reconstructive algorithm for plastic surgery following extensive chest wall resection. Br J Plast Surg, 2004, 57(4): 295-302.
14. Chang RR, Mehrara BJ, Hu QY, et al. Reconstruction of complex oncologic chest wall defects: a 10-year experience. Ann Plast Surg, 2004, 52(5): 471-479.
15. Tukiainen E, Popov P, Asko-Seljavaara S. Microvascular reconstructions of full-thickness oncological chest wall defects. Ann Surg, 2003, 238(6): 794-801.
16. Celik N, Wei FC, Lin CH, et al. Technique and strategy in anterolateral thigh perforator flap surgery, based on an analysis of 15 complete and partial failures in 439 cases. Plast Reconstr Surg, 2002, 109(7): 2211-2216.
17. Wong CH, Wei FC, Fu B, et al. Alternative vascular pedicle of the anterolateral thigh flap: the oblique branch of the lateral circumflex femoral artery. Plast Reconstr Surg, 2009, 123(2): 571-577.
18. Netscher DT, Baumholtz MA. Chest reconstruction: Ⅰ. Anterior and anterolateral chest wall and wounds affecting respiratory function. Plast Reconstr Surg, 2009, 124(5): 240e-252e.
19. Netscher DT, Valkov PL. Reconstruction of oncologic torso defects: emphasis on microvascular reconstruction. Semin Surg Oncol, 2000, 19(3): 255-263.
20. Friedel G, Kuipers T, Dippon J, et al. Full-thickness resection with myocutaneous flap reconstruction for locally recurrent breast cancer. Ann Thorac Surg, 2008, 85(6): 1894-1900.

Chinese Journal of Reparative and Reconstructive Surgery

Application of expanded anterolateral thigh myocutaneous flap in the repair of huge chest wall defect

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