Efficacité de l'association Mersilène ®–lambeau musculocutané dans la reconstruction des pertes de substance transfixiantes du thorax. Étude rétrospective de 14 cas

Abstract

Subject The tumors of chest wall can be responsible of large full-thickness defects. The skeletal stabilization by differents synthetic materials with numerous modalities of use and the superficial coverage of the defect by a musculocutaneous flap are the two imperatives parts of this reconstruction. Patients and methods From January 1997 to January 2006, 14 patients, 10 males and 4 females, aged between 17 and 63 years old and suffering from full-thickness chest wall defects secondary to tumor resection have benefited from a simple reconstruction, wherever the defect, by a Mersilene ® Mesh and a muscular or musculocutaneous flap. These defects measured between 8 × 12 cm and 14 × 16 cm and were located in the anterior part of the chest in 3 cases, with resection of the upper half of the sternum and the internal part of both clavicles and the first three ribs, and in the lateral part of the chest in 11 cases with resection between 3 and 5 ribs. The histological diagnoses of these tumors were 3 chondrosarcomas, 3 sternum and 1 rib metastases, 2 desmoid tumors, 1 Ewing's sarcoma, 4 benign tumors. The flaps used were pedicled in 13 cases and based on the latissimus dorsi muscle, the serratus muscle and the pectoralis major muscle; in 1 case, the latissimus dorsi musculocutaneous flap was free. Results The skeletal stabilisation seems satisfying. There was no problems with the pulmonary function except in 4 cases where a dyspnea appears in sustained effort. No vascular complication on these flaps was noted. With a mean follow up of 46 months, there was no local recurrence of the malignant tumors. Two patients were deceased 1 year after surgery.0. Conclusion The Mersilene ® mesh associated with a locoregional musculocutaneous flap represent a simple and efficient solution for the treatment of such defects.