Chest Wall Reconstruction with Thoracoabdominal Flap for Large Skin Defects after Mastectomy of Advanced Breast Cancer.

Kim, Hak Tae; Yang, Jung Dug; Chung, Ho Yun; Cho, Byung Chae; Kim, Gui Rak; Choi, Kang Young; Lee, Jung Hun; Park, Ho Yong

Original Article

Journal of the Korean Society of Plastic and Reconstructive Surgeons 2010;37(6):736-741.
Published online November 1, 2010.

Chest Wall Reconstruction with Thoracoabdominal Flap for Large Skin Defects after Mastectomy of Advanced Breast Cancer.

Hak Tae Kim, Jung Dug Yang, Ho Yun Chung, Byung Chae Cho, Gui Rak Kim, Kang Young Choi, Jung Hun Lee, Ho Yong Park

¹Department of Plastic and Reconstructive Surgery, College of Medicine, Kyungpook National University, Daegu, Korea. lambyang@paran.com
²Department of Surgery, College of Medicine, Kyungpook National University, Daegu, Korea.

Abstract

PURPOSE
Radical surgical extirpation in advanced breast cancer patients produces extensive loss of skin with large defects requiring plastic surgical procedures for the closure. Many reconstructive methods exist, the choice of which depends upon the characteristic of the wound, extent of resection and patient comorbidities. For adequate coverage of the large skin defects following resection of advanced breast cancer, current authors have performed a thoracoabdominal flap. METHODS: From August 2008 to June 2009, 4 cases of thoraco-abdominal flap were performed for chest wall reconstruction after mastectomy of advanced breast cancer. Flap dissection was entirely performed in a subfascial plane and the flap involving the external oblique abdominal muscle. The flap was rotated clockwise in left chest wall defects and counterclockwise in right chest defects and the donor site was closed directly.
RESULTS
Their mean age, 55.7 years and the average follow-up interval was 9 months. Patients' oncologic status ranged from stage IIIc to stage IV, it was classified according to the TNM staging system. Flap dimensions ranged between 15 x 15 and 25 x 25 cm. One flap sustained a partial loss at the distal margin and revision with pectoralis major musculocutaneous island flap.
CONCLUSION
Large chest wall reconstructions are usually required after radical excision of advanced cancer stages patients with poor general conditions. Thoracoabdominal flap is a simple, quick single-stage procedure, and offer to patient fast recovery, low complication rate, enabling further concomitant adjuvant therapy.

Keywords: Advanced breast cancer; Thoracoabdominal flap; External oblique abdominal muscle