Reconstruction des pertes de substance totales transfixiantes du thorax par combinaison Gore-Tex ®/Marlex ®/lambeau musculocutané. Étude rétrospective de 14 cas

Abstract

To assess the results of surgical resection and chest wall reconstruction we reviewed our experience with the complete chest wall reconstruction after en bloc excisions according to an original algorithm based on the location of the thoracic defect. The 14 reconstructions were performed by the senior author. We found 5 central, 6 lateral and 3 borders locations. In the central locations with a total resection of the sternum the reconstruction was realized by Gore-tex’s ® mesh in depth, metal hooks (staples) and Marlex’s ® mesh under a musculocutaneous flap of coverage. In case of lateral location the reconstruction was realized by Gore-tex’s ® mesh covered with a musculocutaneous flap, the borders locations were reconstructed by Marlex’s mesh and flap of coverage. The histological diagnoses were: one desmoid tumor, eight sarcomas, a recurrence of hepatocarcinoma and four recurrences of breast cancer. The superficial coverage performed by latissimus dorsis flap 12 for cases and rectus abdominis flap for two cases. All the patients were able to produce a spontaneous breath after surgery. Two deaths at distance and an infection were to regret. On the whole the algorithm of reconstruction according to the location of the defect allows a simplification of the indications.