Using Local Flaps in a Chest Wall Reconstruction after Mastectomy for Locally Advanced Breast Cancer

다국어 초록 (Multilingual Abstract)

Background Surgical ablation for locally advanced breast cancer results in large chest wall defects, which can then be managed with local flaps or skin grafts. The purpose of this article is to evaluate the outcomes of three types of local skin flaps.
Methods Among 25 local flaps in 24 patients, 6 were bilateral advancement (BA) flaps, 9 were thoracoabdominal (TA) flaps, and 10 were thoracoepigastric (TE) flaps. Clinical outcomes were compared including complications, the need for a secondary surgical intervention, and the timing of adjuvant therapy.
Results The mean defect size was 436.2 cm². Two patients with TA flaps and 6 patients with TE flaps developed distal flap necrosis, and skin grafts were needed to treat 2 patients with TE flaps. Radiation was administered to the BA, TA, and TE patients after average postoperative durations of 28, 30, or 41 days, respectively. The incidence of flap necrosis tended to be higher in TE patients, which lead to significant delays in adjuvant radiation therapy (P=0.02).
Conclusions Three types of local skin flaps can be used to treat large chest wall defects after the excision of locally advanced breast cancer. Each flap has its own merits and demerits, and selecting flaps should be based on strict indications based on the dimensions and locations of the defects.

참고문헌 (Reference)

1 Matros E, "Uncommon flaps for chest wall reconstruction" 25 : 55-59, 2011

2 Leinster SJ, "Thoraco-abdominal and thoracoepigastric flaps: alternatives to skin grafting after mastectomy" 8 : 145-148, 1982

3 Halsted WS. I., "The results of operations for the cure of cancer of the breast performed at the Johns Hopkins Hospital from June, 1889, to January, 1894" 20 : 497-555, 1894

4 Foster RD, "Safety of immediate transverse rectus abdominis myocutaneous breast reconstruction for patients with locally advanced disease" 140 : 196-198, 2005

5 Rivas B, "Reconstructive management of advanced breast cancer" 47 : 234-239, 2001

6 Skoracki RJ, "Reconstruction of the chestwall and thorax" 94 : 455-465, 2006

7 Deo SV, "Myocutaneous versus thoraco-abdominal flap cover for soft tissue defects following surgery for locally advanced and recurrent breast cancer" 83 : 31-35, 2003

8 McCraw JB, "Methods of soft tissue coverage for the mastectomy defect" 6 : 57-69, 1979

9 Lee MC, "Management of patients with locally advanced breast cancer" 87 : 379-398, 2007

10 Godfrey PM, "Immediate autogenous breast reconstruction in clinically advanced disease" 95 : 1039-1044, 1995

11 Strauch B, "Grabb’s encyclopedia of flaps: upper extremities" Lippincott Williams & Wilkins 981-984, 2009

12 Newman LA, "Feasibility of immediate breast reconstruction for locally advanced breast cancer" 6 : 671-675, 1999

13 Persichetti P, "Extended cutaneous ‘thoracoabdominal’ flap for large chest wall reconstruction" 57 : 177-183, 2006

14 Micali E, "Extended V-Y latissimus dorsi musculocutaneous flap for anterior chest wall reconstruction" 107 : 1382-1390, 2001

15 Baroudi R, "A transverse thoracoabdominal skin flap for closure after radical mastectomy" 61 : 547-554, 1978

16 Ryan JJ., "A lower thoracic advancement flap in breast reconstruction after mastectomy" 70 : 153-160, 1982