Download PDF
Semin Plast Surg 2004; 18(2): 117-129
DOI: 10.1055/s-2004-829046
Copyright © 2004 by Thieme Medical Publishers, Inc., 333 Seventh Avenue, New York, NY 10001 USA.

Chest Wall Reconstruction and Advanced Disease

Elisabeth K. Beahm1 , David W. Chang1
  • 1Department of Plastic Surgery, The University of Texas M. D. Anderson Cancer Center, Houston, TX
Further Information

Publication History

Publication Date:
14 June 2004 (online)

    Permissions and Reprints

Clinical experience supports a role for palliative procedures in patients with locally advanced or recurrent breast cancer, yet numerous challenges are entailed in both the extirpation and reconstruction of the chest wall in these cases. The defects may be profound and complicated by prior surgery, radiation therapy, or patient-related variables. The reconstructive techniques employed must neither encumber nor delay any necessary postoperative therapy and must not result in unacceptable morbidity or compromise quality of life. Our surgical approach to these cases incorporates a team of specialists from a broad spectrum of medical and surgical disciplines. Each operative plan is tailored to the specific needs and requirements of the individual patient.

KEYWORDS

Chest wall reconstruction - advanced breast cancer

REFERENCES

  • 1 Rudolph R, Vande B J, Schneider J A et al.. Slowed growth of cultured fibroblasts from human radiation wounds.  Plast Reconstr Surg. 1988;  82 669-677
    PubMedGoogle Scholar
  • 2 Hopewell J W, Calvo W, Jaenke R et al.. Microvasculature and radiation damage.  Recent Results Cancer Res. 1993;  130 1-16
    PubMedGoogle Scholar
  • 3 Chuang V P. Radiation-induced arthritis.  Semin Roentgenol. 1994;  29 64-69
    CrossrefPubMedGoogle Scholar
  • 4 Mansfield C. Effects of radiation therapy on wound healing after mastectomy.  Clin Plast Surg. 1979;  6 19-26
    PubMedGoogle Scholar
  • 5 Huang E, Perkins G, McNeese M D et al.. Locoregional treatment outcomes for inoperable anthracycline-resistant breast cancer.  Int J Radiat Oncol Biol Physiol. 2002;  53 1225-1233
    PubMedGoogle Scholar
  • 6 Arnold P G, Pairolero P C. Chest-wall reconstruction: an account of 500 consecutive patients.  Plast Reconstr Surg. 1996;  98 804-810
    CrossrefPubMedGoogle Scholar
  • 7 Kroll S S, Schusterman M A, Reece G P et al.. Breast reconstruction with myocutaneous flaps in previously irradiated patients.  Plast Reconstr Surg. 1994;  93 460-469
    CrossrefPubMedGoogle Scholar
  • 8 Williams K J, Carlson G W, Bostwick III J et al.. The effects of radiation treatment after TRAM flap breast reconstruction.  Plast Reconstr Surg. 1997;  100 1153-1160
    CrossrefPubMedGoogle Scholar
  • 9 Arnold P G, Lovich S F, Pairolero P C. Muscle flaps in irradiated wounds: an account of 100 consecutive cases.  Plast Reconstr Surg. 1994;  93 324-327
    CrossrefPubMedGoogle Scholar
  • 10 Arnold P G, Pairolero P C. Surgical management of the radiated chest wall.  Plast Reconstr Surg. 1986;  77 605-612
    CrossrefPubMedGoogle Scholar
  • 11 Tran N V, Chang D W, Gupta A et al.. Comparison of immediate and delayed free TRAM flap breast reconstruction in patients receiving postmastectomy radiation therapy.  Plast Reconstr Surg. 2001;  108 78-82
    CrossrefPubMedGoogle Scholar
  • 12 Wasserman T. Radioprotective effects of amifostine.  Semin Oncol. 1999;  26 89-94
    PubMedGoogle Scholar
  • 13 Argenta L C, Morykwas M J. Vacuum-assisted closure: a new method for wound control and treatment: clinical experience.  Ann Plast Surg. 1997;  38 563-576
    PubMedGoogle Scholar
  • 14 Morykwas M J, Argenta L C. Vacuum-assisted closure: a new method for wound control and treatment: animal studies and basic foundation.  Ann Plast Surg. 1997;  38 563-576
    PubMedGoogle Scholar
  • 15 Irons G B, Witzke D J, Arnold P G, Wood M B. Use of omental transposition flaps for soft-tissue reconstruction.  Ann Plast Surg. 1983;  11 508-512
    PubMedGoogle Scholar
  • 16 Baroudi R, Pinotti J A, Keppke E M. A transverse thoracoabdominal skin flap for closure after radical mastectomy.  Plast Reconstr Surg. 1978;  61 547-554
    CrossrefPubMedGoogle Scholar
  • 17 Baroudi R. Contralateral transverse thoracoabdominal skin flap. In: Strauch B, Vasconez LO, Hall-Findley EJ Grabb's Encyclopedia of Flaps. Boston; Little, Brown 1990: 1345-1348
    Google Scholar
  • 18 Whalen W P. Coverage of thoracic wall defects by a split breast flap.  Plast Reconstr Surg. 1953;  12 64-73
    PubMedGoogle Scholar
  • 19 Hughes K C, Henry M J, Turner J, Manders E K. Design of the cyclops flap for chest-wall reconstruction.  Plast Reconstr Surg. 1997;  100 1146-1151
    CrossrefPubMedGoogle Scholar
  • 20 Gingrass R P. Breast flaps. In: Strauch B, Vasconez LO, Hall-Findley EJ Grabb's Encyclopedia of Flaps. Boston; Little, Brown 1990: 1355-1357
    Google Scholar
  • 21 Harii K, Wamada A, Ishihara K et al.. A free transfer of both latissimus dorsi and serratus anterior flaps with thoracodorsal vessel anastomoses.  Plast Reconstr Surg. 1982;  70 620-629
    CrossrefPubMedGoogle Scholar
  • 22 Tansini I. Sopra il mio nuovo processo di amputazione della mammella.  Gazet Med Ital. 1906;  57 141-151
    PubMedGoogle Scholar
  • 23 Koshima I, Saisho H, Kawada S et al.. Flow through thin latissimus dorsi perforator flap for repair of soft tissue defects in the legs.  Plast Reconstr Surg. 1999;  103 1483-1490
    CrossrefPubMedGoogle Scholar
  • 24 Kim J T. Latissimus dorsi perforator flap.  Clin Plast Surg. 2003;  30 403-431
    CrossrefPubMedGoogle Scholar
  • 25 Tobin G R, Moberg A W, DuBou R H et al.. The split latissimus dorsi myocutaneous flap.  Ann Plast Surg. 1981;  7 272-280
    CrossrefPubMedGoogle Scholar
  • 26 McCraw J B, Papp C T. Latissimus dorsi myocutaneous flap. In: Hartrampf CR Breast Reconstruction with Living Tissue. New York; Raven Press 1991: 211
    Google Scholar
  • 27 Delay E, Gounot N, Bouillot A et al.. Autologous latissimus breast reconstruction: a 3-year clinical experience with 100 patients.  Plast Reconstr Surg. 1998;  102 1461-1478
    CrossrefPubMedGoogle Scholar
  • 28 Lin C H, Wei F C, Levin L S, Chen M C. Donor-site morbidity comparison between endoscopically assisted and traditional harvest of free latissimus dorsi muscle flap.  Plast Reconstr Surg. 1999;  104 1070-1077
    CrossrefPubMedGoogle Scholar
  • 29 Titley O G, Spyrou G E, Fatah M F. Preventing seroma in the latissimus dorsi flap donor site.  Br J Plast Surg. 1997;  50 106-108
    CrossrefPubMedGoogle Scholar
  • 30 Schwabegger A, Ninkovic M, Brenner E, Anderl H. Seroma as a common donor site morbidity after harvesting the latissimus dorsi flap: observations on cause and prevention.  Ann Plast Surg. 1997;  38 594-597
    CrossrefPubMedGoogle Scholar
  • 31 Laitung J FG, Peck F. Shoulder function following the loss of the latissimus dorsi muscle.  Br J Plast Surg. 1985;  38 375-379
    CrossrefPubMedGoogle Scholar
  • 32 Russell R C, Pribaz J, Zook E G et al.. Functional evaluation of latissimus dorsi donor site.  Plast Reconstr Surg. 1986;  78 336-344
    CrossrefPubMedGoogle Scholar
  • 33 Fraulin F O, Louie G, Zorrilla L, Tilley W. Functional evaluation of the shoulder following latissimus dorsi muscle transfer.  Ann Plast Surg. 1995;  35 349-353
    CrossrefPubMedGoogle Scholar
  • 34 Fisher J, Bostwick III J, Powell R W. Latissimus dorsi blood supply after thoracodorsal vessel division: the serratus collateral.  Plast Reconstr Surg. 1983;  72 502-511
    CrossrefPubMedGoogle Scholar
  • 35 Salmon R J, Razaboni R, Soussaline M. The use of the latissimus dorsi musculocutaneous flap following recurrence of cancer in irradiated breasts.  Br J Plast Surg. 1988;  41 41-44
    CrossrefPubMedGoogle Scholar
  • 36 Mathes S J, Bostwick III J. A rectus abdominis myocutaneous flap to reconstruct abdominal wall defects.  Br J Plast Surg. 1977;  30 282-283
    CrossrefPubMedGoogle Scholar
  • 37 Cormack G C, Lamberty G H. The Arterial Anatomy of Skin Flaps. Edinburgh, NY; Churchill Livingstone 1986
    Google Scholar
  • 38 Hartrampf C R, Scheflan M, Black P W. Breast reconstruction with a transverse abdominal island flap.  Plast Reconstr Surg. 1982;  69 216-225
    CrossrefPubMedGoogle Scholar
  • 39 Paletta C E, Vogler G, Freedman B. Viability of the rectus abdominis muscle following internal mammary artery ligation.  Plast Reconstr Surg. 1993;  92 234-237
    Google Scholar
  • 40 Scheflan M, Dinner M I. The transverse abdominal island flap: part I. Indications, contraindications, results, and complications.  Ann Plast Surg. 1983;  10 24-35
    CrossrefPubMedGoogle Scholar
  • 41 Wagner D S, Michelow B J, Hartrampf Jr C R. Double-pedicle TRAM flap for unilateral breast reconstruction.  Plast Reconstr Surg. 1991;  88 987-997
    PubMedGoogle Scholar
  • 42 Schusterman M A, Kroll S S, Miller M J. The free TRAM flap for breast reconstruction: a single center's experience with 211 consecutive cases.  Ann Plast Surg. 1994;  32 234-241
    CrossrefPubMedGoogle Scholar
  • 43 Slavin S A, Goldwyn R M. The midabdominal rectus abdominis myocutaneous flap: review of 236 flaps.  Plast Reconstr Surg. 1988;  81 189-199
    PubMedGoogle Scholar
  • 44 Blondeel P N, Boeckx W D, Vanderstraeten G G et al.. The fate of the oblique abdominal muscles after free TRAM flap surgery.  Br J Plast Surg. 1997;  50 315-321
    CrossrefPubMedGoogle Scholar
  • 45 Blondeel P N, Vanderstraeten G G, Monstrey S J et al.. The donor site morbidity of free DIEP flaps and free TRAM flaps for breast reconstruction.  Br J Plast Surg. 1997;  50 322-330
    Google Scholar
  • 46 Rivas B, Carrillo J, Escobar G. Reconstructive management of advanced breast cancer.  Ann Plast Surg. 2001;  47 234-239
    PubMedGoogle Scholar
  • 47 Lesnick G J, Davids A M. Repair of surgical abdominal wall defect with a pedicled musculofascial flap.  Ann Surg. 1953;  137 569-572
    PubMedGoogle Scholar
  • 48 Moschella F, Cordova A. A new extended external oblique musculocutaneous flap for reconstruction of large chest-wall defects.  Plast Reconstr Surg. 1999;  103 1378-1385
    CrossrefPubMedGoogle Scholar
  • 49 Bogossian N, Chaglassian T, Rosenberg P, Moore M. External oblique myocutaneous flap coverage of large chest-wall defects following resection of breast tumors.  Plast Reconstr Surg. 1996;  97 97-103
    CrossrefPubMedGoogle Scholar
  • 50 Netscher D T, Valkov P L. Reconstruction of oncologic torso defects: emphasis on microvascular reconstruction.  Semin Surg Oncol. 2000;  19 255-263
    CrossrefPubMedGoogle Scholar
  • 51 Cordiero P G, Cohen S et al.. The total volar forearm musculocutaneous free flap for reconstruction of extended forequarter amputations.  Ann Plast Surg. 1998;  40 388-396
    PubMedGoogle Scholar
  • 52 Kuhn J A, Wagman L D, Lorant J A et al.. Radical forequarter amputation with hemithoracectomy and free extended forearm flap: Technical and physiologic considerations.  Ann Surg Oncol. 1994;  1 353-359
    PubMedGoogle Scholar
  • 53 Vandenburgh H H. Mechanical forces and their second messengers in stimulating cell growth in vitro.  Am J Physiol. 1992;  262 R350-355
    PubMedGoogle Scholar
  • 54 Song D H, Wu L C, Lohman R F et al.. Vacuum assisted closure for the treatment of sternal wounds: the bridge between debridement and definitive closure.  Plast Reconstr Surg. 2003;  111 92-97
    CrossrefPubMedGoogle Scholar
  • 55 Kroll S S, Walsh G, Ryan B, King R. Risks and benefits of using Marlex mesh in chest wall reconstruction.  Ann Plast Surg. 1993;  31 303-306
    CrossrefPubMedGoogle Scholar
  • 56 McCormack P M. Use of prosthetic materials in chest wall reconstruction: assets and liabilities.  Surg Clin North Am. 1989;  69 965-976
    PubMedGoogle Scholar
  • 57 McKenna Jr R J, Mountain C F, McMurtrey M J et al.. Current techniques for chest wall reconstruction: expanded possibilities for treatment.  Ann Thorac Surg. 1988;  46 508-512
    PubMedGoogle Scholar
  • 58 Lardinois D, Muller M, Furrer M et al.. Functional assessment of chest wall integrity after methylmethacrylate reconstruction.  Ann Thorac Surg. 2000;  69 919-923
    CrossrefPubMedGoogle Scholar
  • 59 McCormack P M, Bains M S, Burt M E et al.. Local recurrent mammary carcinoma failing multimodality therapy.  Arch Surg. 1989;  124 158-161
    PubMedGoogle Scholar

Elisabeth K BeahmM.D. F.A.C.S. 

Associate Professor, Department of Plastic Surgery-Unit 443, The University of Texas M. D. Anderson Cancer Center

1515 Holcombe Boulevard

Houston, TX 77030

      >