Objective To summarize the clinical results and experience of combined transplantation of bilateral free anterolateral thigh myocutaneous flaps to repair large full-thickness chest wall defects after radical resection of tumor. Methods From January 2011 to December 2018, 22 patients who needed full-thickness chest wall reconstruction by using using bilateral femoral anterolateral free myocutaneous flap combined with titanium alloy scaffold or bone cement were admitted to our unit. The area of chest wall defect ranged from 300 cm2 to 700 cm2 (median area was 360 cm2). A total of 44 myocutaneous flaps were designed and harvested, with skin area of (173.55±67.78) cm2 and muscle area of (158.68±94.93) cm2. The flaps were transferred to the chest wall defect, and the arteries were anastomosed in end-to-end manner. According to the number of available arteries in the recipient area, the arterial blood supply of the two musculocutaneous flaps was reconstructed by outer-supercharging or inner-supercharging. During venous anastomosis, different anastomosis strategies were adopted according to the number and pattern of different veins in the vascular pedicle and recipient area. Results All 44 myocutaneous flaps from 22 patients survived, while 1 myocutaneous flap had partial necrosis at the distal end, and the wound healed after debridement. All 44 wounds at the donor sites of bilateral thighs healed smoothly, leaving only linear scars. Patients were followed up for 6 to 36 months (18.27±8.62 months), and no local recurrence was found. Bone metastasis was found in one breast cancer patient. The texture of the reconstructed chest wall was good, the patient's breathing was normal, the muscle strength and joint activity of both lower limbs were not affected, and the patient's satisfaction was high. Conclusions The combined transplantation of bilateral free anterolateral thigh myocutaneous flaps can cover the chest wall defects well. At the same time, according to the different vascular anatomy, the myocutaneous flaps can protect the function of the donor site to the greatest extent, which is a reliable method for chest wall reconstruction.
Key words
Anterolateral thigh myocutaneous flap /
/
/
Descending branch of lateral circumflex femoral artery /
/
/
Vascular anastomosis /
/
/
Chest wall repair
{{custom_sec.title}}
{{custom_sec.title}}
{{custom_sec.content}}
References
[1] Corkum JP, Garvey PB, Baumann DP, et al. Reconstruction of massive chest wall defects: a 20-year experience[J]. J Plast Reconstr Aesthet Surg, 2020, 73(6): 1091-1098. DOI: 10.1016/j.bjps.2020.02.010.
[2] Dai Z, Maihemuti M, Sun Y, et al. Resection and reconstruction of huge tumors in the chest wall[J]. J Cardiothorac Surg, 2022, 17(1): 116. DOI: 10.1186/s13019-022-01877-9.
[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[J]. Ann Plast Surg, 2020, 84(3): 293-299. DOI: 10.1097/SAP.0000000000002000.
[4] 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]. J Plast Reconstr Aesthet Surg, 2010, 63(1): 120-125. DOI: 10.1016/j.bjps.2008.08.022.
[5] Salo JTK, Tukiainen EJ. Oncologic resection and reconstruction of the chest wall: a 19-year experience in a single center[J]. Plast Reconstr Surg, 2018, 142(2): 536-547. DOI: 10.1097/PRS.0000000000004597.
[6] Smelt J, Pontiki A, Jahangiri M, et al. Three-dimensional printing for chest wall reconstruction in thoracic surgery: building on experience[J]. Thorac Cardiovasc Surg, 2020, 68(4): 352-356. DOI: 10.1055/s-0039-1678611.
[7] Vanstraelen S, Ali B, Bains MS, et al. The contribution of microvascular free flaps and pedicled flaps to successful chest wall surgery[J]. J Thorac Cardiovasc Surg, 2023, 166(4): 1262-1272.e2. DOI: 10.1016/j.jtcvs.2023.05.018.
[8] Zhao ZQ, Zhu XQ, Zhu MR, et al. Chest wall reconstruction of male: Latissimus dorsi Kiss flap, rectus abdominis flap and Titanium-mesh[J]. Asian J Surg,2022, 45(7): 1443-1444. DOI: 10.1016/j.asjsur. 2022.02.041.
[9] Wang CM, Zhang R, Luo P, et al. Reconstruction of extensive thoracic wall defect using the external oblique myocutaneous flap: an analysis on 20 Chinese patients with locally advanced soft tissue sarcoma[J]. J Surg Oncol, 2018, 117(2): 130-136. DOI: 10.1002/jso.24823.
[10]Ouyang Y, Xu B, Luan J, et al. Chest wall reconstruction in male poland syndrome patients with endoscopic-assisted latissimus dorsi muscle flap transfer[J]. J Plast Reconstr Aesthet Surg, 2021, 74(11): 3141-3149. DOI: 10.1016/j.bjps.2021.03.117.
[11]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[J]. Ann Plast Surg, 2002, 48(2): 161-166. DOI: 10.1097/00000637-200202000-00008.
[12]Alsharkawy K, Youssif S, Malahias M, et al. Acromiothoracic venous supercharge for abdominal-based free flaps in breast and chest wall reconstruction[J]. Ann Plast Surg, 2023, 91(6): 734-739. DOI: 10.1097/SAP.0000000000003704.
[13]Breidung D, Delavari S, Grimme S, et al. Postoperative complications of flap procedures in chest wall defect reconstruction: a two-center experience[J]. Medicina (Kaunas), 2024, 60(5): 834. DOI: 10.3390/medicina60050834.
[14]聂开瑜, 常树森, 魏在荣, 等. 旋股外侧动脉降支穿支皮瓣显微削薄的临床应用[J]. 中国临床解剖学杂志, 2017, 35(1): 90-93. DOI: 10.13418/j.issn.1001-165x.2017.01.018.
[15]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[J]. 中国修复重建外科杂志, 2022, 36(7): 834-839. DOI: 10.7507/1002-1892.202202001.
PDF(3487 KB)
