Surgical management of non-small cell lung cancer (NSCLC) invading chest wall is the combination of pulmonary resection, lymphadenectomy and chest wall resection and reconstruction. Hitherto the surgical procedures include combination of thoracotomy and video-assisted thoracoscopic surgery (VATS), thoracotomy, and VATS. The result of the surgery leads to a defect in the chest wall. Therefore, the requirements of the technique and material are relatively high with no consensual standard. This review describes the definitions, indications, materials, prognostic factors, and recent progress in surgical techniques.
Over a two year period, four patients of pectus carinatum received surgical correction at our hospital. All patients were followed up for 6 months to 1 year. The operative results were satisfactory but one required revision with additional resection of bilateral second cartilage for the persistent malformation. The clinical characteristics, operative techniques and indications for operative treatment were discussed.
The sternoclavicular joint is located at the cervicothoracic junction, where various types of lesions such as trauma, infection, inflammation and tumor can occur. In complex chest wall reconstruction, the sternoclavicular joint is often involved. Whether and how to reconstruct the sternoclavicular joint is a difficult problem for surgeons. At present, there is no unified standard for sternoclavicular joint resection and reconstruction. There are many materials and methods for sternoclavicular joint reconstruction. With the development of surgical techniques and treatment concepts, we have a new understanding of the anatomy, function, and surgical treatment of the sternoclavicular joint. This article provides an overview of these developments.
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.
ObjectiveTo 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. ConclusionThe 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.