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Ann Thorac Surg 2001;72:1720-1724
© 2001 The Society of Thoracic Surgeons

Original article: general thoracic

A novel technique for the reconstruction of infected full-thickness chest wall defects

Wassim Raffoul, MDa, Michael Dusmet, MD*b, Michel Landry, MDc, Hans-Beat Ris, MDb

a Division of Plastic and Reconstructive Surgery, Centre Hospitalier Universitaire Vaudois, Lausanne, Switzerland
b Division of Thoracic Surgery, Centre Hospitalier Universitaire Vaudois, Lausanne, Switzerland
c Division of Radiology, Centre Hospitalier Universitaire Vaudois, Lausanne, Switzerland

Accepted for publication July 10, 2001.

* Address reprint requests to Dr Dusmet, Division of Thoracic Surgery, Centre Hospitalier Universitaire Vaudois, 1011 Lausanne, Switzerland
e-mail: michael.dusmet{at}chuv.hospvd.ch

Background. Chest wall resection and reconstruction can be performed with minimal mortality and excellent functional and cosmetic results using synthetic meshes, methylmethacrylate, or other substitutes. However, these techniques are less easily applicable if chest wall resections have to be performed for infections.

Methods. We report a novel technique for this purpose using a modified latissimus dorsi flap harvested in continuity with the thoracolumbar fascia. The vascularized fascia was sutured into the chest wall defect, providing a stable base for the muscular component of the flap. Three patients requiring large full-thickness resections of the anterolateral chest wall for chronic infections were treated accordingly, two presenting with chronic radionecrosis and osteomyelitis and one with chest wall invasion by pulmonary aspergillosis.

Results. There were no intraoperative or postoperative complications and immediate extubation was possible in all 3 patients without the need for postoperative ventilation or tracheotomy. Healing of the infected chest wall was observed in all 3 patients. Postoperative cine-magnetic resonance imaging revealed concordant movements of the replaced segments without evidence of paradoxical motion during inspiration and expiration.

Conclusions. This technique is easy and safe. It allows a stable and satisfactory reconstruction after large anterolateral full-thickness chest wall resections of infected, previously irradiated tissues, using only well-vascularized autologous tissue.






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Copyright © 2001 by The Society of Thoracic Surgeons.