A Twelve-Year Consecutive Case Experience in Thoracic Reconstruction

• Published in: Plastic and reconstructive surgery. Global open Vol. 4; no. 3; p. e638
• Main Authors: Chen, Jenny T, Bonneau, Laura A, Weigel, Tracey L, Maloney, James D, Castro, Francisco, Shulzhenko, Nikita, Bentz, Michael L
• Format: Journal Article
• Language: English
• Published: United States American Society of Plastic Surgeons 01.03.2016; Wolters Kluwer Health
• Subjects: Original
• ISSN: 2169-7574; 2169-7574
• DOI: 10.1097/GOX.0000000000000603

BACKGROUND:We describe the second largest contemporary series of flaps used in thoracic reconstruction. METHODS:A retrospective review of patients undergoing thoracomyoplasty from 2001 to 2013 was conducted. Ninety-one consecutive patients were identified. RESULTS:Thoracomyoplasty was performed for 67 patients with intrathoracic indications and 24 patients with chest wall defects. Malignancy and infection were the most common indications for reconstruction (P < 0.01). The latissimus dorsi (LD), pectoralis major, and serratus anterior muscle flaps remained the workhorses of reconstruction (LD and pectoralis major64% flaps in chest wall reconstruction; LD and serratus anterior85% of flaps in intrathoracic indication). Only 12% of patients required mesh. Only 6% of patients with <2 ribs resected required mesh when compared with 24% with 3–4 ribs, and 100% with 5 or more ribs resected (P < 0.01). Increased rib resections required in chest wall reconstruction resulted in a longer hospital stay (P < 0.01). Total comorbidities and complications were related to length of stay only in intrathoracic indication (P < 0.01). Average intubation time was significantly higher in patients undergoing intrathoracic indication (5.51 days) than chest wall reconstruction (0.04 days), P < 0.05. Average hospital stay was significantly higher in patients undergoing intrathoracic indication (23 days) than chest wall reconstruction (12 days), P < 0.05. One-year survival was most poor for intrathoracic indication (59%) versus chest wall reconstruction (83%), P = 0.0048. CONCLUSION:Thoracic reconstruction remains a safe and successful intervention that reliably treats complex and challenging problems, allowing more complex thoracic surgery problems to be salvaged.