Multi-flap reconstruction for a recurrent giant phyllodes tumor

Abstract

Few case reports have discussed the incidence and management of giant recurrent phyllodes tumors with borderline to malignant features. We report that of a recurrent case in a 57-year-old female who underwent wide excision with en bloc resection of the 3rd to 7th right anterior ribs and upper abdominal wall. Rigid chest wall reconstruction was achieved using methyl methacrylate and synthetic mesh. This is the first reported case wherein three locoregional flaps, namely the latissimus dorsi, thoracoepigastric and extended external oblique flaps were used to cover a defect measuring 1452 cm2 in size. With this combination of flaps, deformity was minimized, and the resultant outcome was aesthetically and functionally acceptable. Reconstructive goals of intrathoracic organ protection, restoration of chest wall rigidity, maintenance of adequate respiratory function and soft tissue closure were achieved. Careful planning and individualized treatment together with multidisciplinary collaboration remains vital in the successful management of large recurrent malignant phyllodes tumors.