Effectiveness of lobulated pedicled rectus abdominis myocutaneous flap for repairing huge chest wall defect_Chinese Journal of Reparative and Reconstructive Surgery

Authors：

SONG Dajiang ¹ ,  LI Zan ¹ , ZHANG Yixin ²

1. Department of Oncology Plastic Surgery, Hunan 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：

Huge chest wall defect; rectus abdominis myocutaneous flap; chest wall reconstruction; lobulated flap

DOI：

10.7507/1002-1892.202212101

Video：

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Objective To explore the effectiveness of lobulated pedicled rectus abdominis myocutaneous flap to repair huge chest wall defect. Methods Between June 2021 and June 2022, 14 patients with huge chest wall defects were treated with radical resection of the lesion and lobulated pedicled rectus abdominis myocutaneous flap transplantation for reconstruction of chest wall defects. The patients included 5 males and 9 females with an average age of 44.2 years (range, 32-57 years). The size of skin and soft tissue defect ranged from 20 cm×16 cm to 22 cm×22 cm. The bilateral pedicled rectus abdominis myocutaneous flaps in size of 26 cm×8 cm to 35 cm×14 cm were prepaired and cut into two skin paddles with basically equal area according to the actual defect size of the chest wall. After the lobulated pedicled rectus abdominis myocutaneous flap was transferred to the defect, there were two reshaping methods. The first method was that the skin paddle at the lower position and opposite side was unchanged, and the skin paddle at the effected side was rotated by 90° (7 cases). The second method was that the two skin paddles were rotated 90° respectively (7 cases). The donor site was sutured directly. Results All 14 flaps survived successfully and the wound healed by first intention. The incisions at donor site healed by first intention. All patients were followed up 6-12 months (mean, 8.7 months). The appearance and texture of the flaps were satisfactory. Only linear scar was left at the donor site, and the appearance and activity of the abdominal wall were not affected. No local recurrence was found in all tumor patients, and distant metastasis occurred in 2 breast cancer patients (1 liver metastasis and 1 lung metastasis). Conclusion The lobulated pedicled rectus abdominis myocutaneous flap in repair of huge chest wall defect can ensure the safety of blood supply of the flap to the greatest extent, ensure the effective and full use of the flap tissue, and reduce postoperative complications.

Citation： SONG Dajiang, LI Zan, ZHANG Yixin. Effectiveness of lobulated pedicled rectus abdominis myocutaneous flap for repairing huge chest wall defect. Chinese Journal of Reparative and Reconstructive Surgery, 2023, 37(4): 473-477. doi: 10.7507/1002-1892.202212101 Copy

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2.	Clough KB, Lewis JS, Couturaud B, et al. Oncoplastic techniques allow extensive resections for breast-conserving therapy of breast carcinomas. Ann Surg, 2003, 237(1): 26-34.
3.	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.
4.	Arya R, Chow WT, Rozen WM, et al. 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. J Reconstr Microsurg, 2016, 32(2): 121-127.
5.	Lim W, Ko BS, Kim HJ, et al. Oncological safety of skin sparing mastectomy followed by immediate reconstruction for locally advanced breast cancer. J Surg Oncol, 2010, 102(1): 39-42.
6.	Zhang YX, Messmer C, Pang FK, et al. A novel design of the multilobed latissimus dorsi myocutaneous flap to achieve primary donor-site closure in the reconstruction of large defects. Plast Reconstr Surg, 2013, 131(5): 752e-758e.
7.	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.
8.	Vyas RM, Dickinson BP, Fastekjian JH, et al. Risk factors for abdominal donor-site morbidity in free flap breast reconstruction. Plast Reconstr Surg, 2008, 121(5): 1519-1526.
9.	Foster RD, Hansen SL, Esserman LJ, et al. Safety of immediate transverse rectus abdominis myocutaneous breast reconstruction for patients with locally advanced disease. Arch Surg, 2005, 140(2): 196-198.
10.	Slavin SA, Love SM, Goldwyn RM. Recurrent breast cancer following immediate reconstruction with myocutaneous flaps. Plast Reconstr Surg, 1994, 93(6): 1191-1204.
11.	Zhang YX, Hayakawa TJ, Levin LS, et al. The economy in autologous tissue transfer: Part 1. The kiss flap technique. Plast Reconstr Surg, 2016, 137(3): 1018-1030.
12.	Giordano SH. Update on locally advanced breast cancer. Oncologist, 2003, 8(6): 521-530.
13.	Skoracki RJ, Chang DW. Reconstruction of the chestwall and thorax. J Surg Oncol, 2006, 94(6): 455-465.
14.	Micali E, Carramaschi FR. Extended V-Y latissimus dorsi musculocutaneous flap for anterior chest wall reconstruction. Plast Reconstr Surg, 2001, 107(6): 1382-1390.
15.	Munhoz AM, Montag E, Arruda E, et al. Immediate locally advanced breast cancer and chest wall reconstruction: surgical planning and reconstruction strategies with extended V-Y latissimus dorsi myocutaneous flap. Plast Reconstr Surg, 2011, 127(6): 2186-2197.
16.	Woo E, Tan BK, Koong HN, et al. Use of the extended V-Y latissimus dorsi myocutaneous flap for chest wall reconstruction in locally advanced breast cancer. Ann Thorac Surg, 2006, 82(2): 752-755.
17.	王蕾, 宋达疆, 宋爱莉, 等. 优化设计分叶背阔肌皮瓣修复局部晚期乳腺癌术后胸壁缺损. 中国修复重建外科杂志, 2021, 35(9): 1172-1176.
18.	宋达疆, 李赞, 章一新, 等. 扩大股前外侧肌皮瓣在超大面积胸壁缺损修复中的应用. 中国修复重建外科杂志, 2022, 36(7): 834-839.
19.	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.
20.	Temple CL, Strom EA, Youssef A, et al. Choice of recipient vessels in delayed TRAM flap breast reconstruction after radiotherapy. Plast Reconstr Surg, 2005, 115(1): 105-113.
21.	Healy C, Allen RJ. The evolution of perforator flap breast reconstruction: twenty years after the first DIEP flap. J Reconstr Microsurg, 2014, 30(2): 121-125.
22.	Nahabedian MY, Momen B, Galdino G, et al. Breast Reconstruction with the free TRAM or DIEP flap: patient selection, choice of flap, and outcome. Plast Reconstr Surg, 2002, 110(2): 466-475.
23.	李赞, 宋达疆. 肿瘤性复杂性胸壁缺损的修复策略及对肿瘤治疗的积极影响. 中华整形外科杂志, 2020, 36(3): 231-241.
24.	Chen CM, Halvorson EG, Disa JJ, et al. Immediate postoperative complications in DIEP versus free/muscle-sparing TRAM flaps. Plast Reconstr Surg, 2007, 120(6): 1477-1482.
25.	吕春柳, 李赞, 周晓, 等. 带蒂背阔肌Kiss皮瓣修复肿瘤切除术后胸壁皮肤软组织缺损的临床研究. 中国修复重建外科杂志, 2016, 30(12): 1498-1501.

1. Emiroglu M, Sert I, Karaali C, et al. The effectiveness of simultaneous oncoplastic breast surgery in patients with locally advanced breast cancer. Breast Cancer, 2016, 23(3): 463-470.
2. Clough KB, Lewis JS, Couturaud B, et al. Oncoplastic techniques allow extensive resections for breast-conserving therapy of breast carcinomas. Ann Surg, 2003, 237(1): 26-34.
3. 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.
4. Arya R, Chow WT, Rozen WM, et al. 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. J Reconstr Microsurg, 2016, 32(2): 121-127.
5. Lim W, Ko BS, Kim HJ, et al. Oncological safety of skin sparing mastectomy followed by immediate reconstruction for locally advanced breast cancer. J Surg Oncol, 2010, 102(1): 39-42.
6. Zhang YX, Messmer C, Pang FK, et al. A novel design of the multilobed latissimus dorsi myocutaneous flap to achieve primary donor-site closure in the reconstruction of large defects. Plast Reconstr Surg, 2013, 131(5): 752e-758e.
7. 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.
8. Vyas RM, Dickinson BP, Fastekjian JH, et al. Risk factors for abdominal donor-site morbidity in free flap breast reconstruction. Plast Reconstr Surg, 2008, 121(5): 1519-1526.
9. Foster RD, Hansen SL, Esserman LJ, et al. Safety of immediate transverse rectus abdominis myocutaneous breast reconstruction for patients with locally advanced disease. Arch Surg, 2005, 140(2): 196-198.
10. Slavin SA, Love SM, Goldwyn RM. Recurrent breast cancer following immediate reconstruction with myocutaneous flaps. Plast Reconstr Surg, 1994, 93(6): 1191-1204.
11. Zhang YX, Hayakawa TJ, Levin LS, et al. The economy in autologous tissue transfer: Part 1. The kiss flap technique. Plast Reconstr Surg, 2016, 137(3): 1018-1030.
12. Giordano SH. Update on locally advanced breast cancer. Oncologist, 2003, 8(6): 521-530.
13. Skoracki RJ, Chang DW. Reconstruction of the chestwall and thorax. J Surg Oncol, 2006, 94(6): 455-465.
14. Micali E, Carramaschi FR. Extended V-Y latissimus dorsi musculocutaneous flap for anterior chest wall reconstruction. Plast Reconstr Surg, 2001, 107(6): 1382-1390.
15. Munhoz AM, Montag E, Arruda E, et al. Immediate locally advanced breast cancer and chest wall reconstruction: surgical planning and reconstruction strategies with extended V-Y latissimus dorsi myocutaneous flap. Plast Reconstr Surg, 2011, 127(6): 2186-2197.
16. Woo E, Tan BK, Koong HN, et al. Use of the extended V-Y latissimus dorsi myocutaneous flap for chest wall reconstruction in locally advanced breast cancer. Ann Thorac Surg, 2006, 82(2): 752-755.
17. 王蕾, 宋达疆, 宋爱莉, 等. 优化设计分叶背阔肌皮瓣修复局部晚期乳腺癌术后胸壁缺损. 中国修复重建外科杂志, 2021, 35(9): 1172-1176.
18. 宋达疆, 李赞, 章一新, 等. 扩大股前外侧肌皮瓣在超大面积胸壁缺损修复中的应用. 中国修复重建外科杂志, 2022, 36(7): 834-839.
19. 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.
20. Temple CL, Strom EA, Youssef A, et al. Choice of recipient vessels in delayed TRAM flap breast reconstruction after radiotherapy. Plast Reconstr Surg, 2005, 115(1): 105-113.
21. Healy C, Allen RJ. The evolution of perforator flap breast reconstruction: twenty years after the first DIEP flap. J Reconstr Microsurg, 2014, 30(2): 121-125.
22. Nahabedian MY, Momen B, Galdino G, et al. Breast Reconstruction with the free TRAM or DIEP flap: patient selection, choice of flap, and outcome. Plast Reconstr Surg, 2002, 110(2): 466-475.
23. 李赞, 宋达疆. 肿瘤性复杂性胸壁缺损的修复策略及对肿瘤治疗的积极影响. 中华整形外科杂志, 2020, 36(3): 231-241.
24. Chen CM, Halvorson EG, Disa JJ, et al. Immediate postoperative complications in DIEP versus free/muscle-sparing TRAM flaps. Plast Reconstr Surg, 2007, 120(6): 1477-1482.
25. 吕春柳, 李赞, 周晓, 等. 带蒂背阔肌Kiss皮瓣修复肿瘤切除术后胸壁皮肤软组织缺损的临床研究. 中国修复重建外科杂志, 2016, 30(12): 1498-1501.

Chinese Journal of Reparative and Reconstructive Surgery

Effectiveness of lobulated pedicled rectus abdominis myocutaneous flap for repairing huge chest wall defect

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