Reconstruction of complex chest wall defects by using polypropylene mesh and a pedicled latissimus dorsi flap: a 6-year experience

Abstract

Reconstruction of full thickness defects of the chest wall is controversial and presents a complicated treatment scenario for thoracic and reconstructive plastic surgeons. It requires close cooperation between the cardiothoracic and reconstructive surgeons to achieve an optimal outcome and reduce the incidence of complications. The purpose of this study is to evaluate our results in patients who underwent prosthetic bony reconstruction with polypropylene mesh and pedicle latissimus dorsi flap after chest wall resection. The principles of chest wall reconstruction include: wide excision of primary chest wall tumour with macroscopically healthy margins, wound excision and debridement of necrotic devitalised and irradiated tissues, control of infection and local wound care. This is a descriptive study. It includes 20 patients who underwent chest wall resection due to various causes and followed by reconstruction with polypropylene mesh along with pedicled latissimus dorsi flap. The study was conducted at the Department of Plastic and Reconstructive Surgery, Federal Postgraduate Medical Institute, Sheikh Zayed Hospital Lahore, over a period of 6 years from August 1999 to August 2005. This study included 20 patients who underwent chest wall reconstruction using polypropylene mesh and pedicled latissimus dorsi flap from August 1999 to August 2005. Patient demographic data including age, sex, pathological diagnosis, extent and type of resection, size of defect, and outcome were recorded. All patients were followed up in our outpatients department for 1 year. There was a total of 20 patients, 16 males and four females. The average age was 54 years (range 44-64 years). The indications for resection were primary chest wall tumours in 13 (65%) patients, local recurrence from breast tumours in one (5%) patient, post median sternotomy in three (15%) patients and radionecrosis in three (15%) patients. Ribs along with a part of sternum were resected in 14 (70%) patients, ribs along with clavicle in two (10%) patients and ribs only in four (20%) patients. The average area of chest wall defect after resection was 16.5 x 13 cm. In all patients, skeletal defect was reconstructed with polypropylene mesh. Soft tissue coverage was provided with a pedicled latissimus dorsi flap in all cases. Three patients with a chest wall tumour developed a recurrence within 6 months. Among these three, one patient died within 8 months of follow up due to myocardial infarction. Chest wall resection and reconstruction with synthetic polypropylene mesh and local muscle flaps can be performed as a safe, effective one-stage surgical procedure for a variety of major chest wall defects.