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CC BY-NC-ND 4.0 · Indian J Plast Surg 2023; 56(02): 166-172
DOI: 10.1055/s-0043-1761177
Case Series

Challenges in Complex Oncological Chest Wall Reconstruction with Free Anterolateral Thigh Flap and Titanium Rib Plate

Cheng Siew Chai 
1   Department of Plastic and Reconstructive Surgery, Hospital Kuala Lumpur, Jalan Pahang, Kuala Lumpur, Malaysia
,
Kasthuri Shamugam
1   Department of Plastic and Reconstructive Surgery, Hospital Kuala Lumpur, Jalan Pahang, Kuala Lumpur, Malaysia
,
Normala Binti Basiron
1   Department of Plastic and Reconstructive Surgery, Hospital Kuala Lumpur, Jalan Pahang, Kuala Lumpur, Malaysia
,
Mohammad Ali Bin Mat Zain
1   Department of Plastic and Reconstructive Surgery, Hospital Kuala Lumpur, Jalan Pahang, Kuala Lumpur, Malaysia
,
Hamidah Binti Zainal
1   Department of Plastic and Reconstructive Surgery, Hospital Kuala Lumpur, Jalan Pahang, Kuala Lumpur, Malaysia
,
Koh Khai Luen
1   Department of Plastic and Reconstructive Surgery, Hospital Kuala Lumpur, Jalan Pahang, Kuala Lumpur, Malaysia
,
Narasimman Sathiamurthy
2   Thoracic Surgery Unit, Department of General Surgery, Hospital Kuala Lumpur, Jalan Pahang, Kuala Lumpur, Malaysia
,
Diong Nguk Chai 
2   Thoracic Surgery Unit, Department of General Surgery, Hospital Kuala Lumpur, Jalan Pahang, Kuala Lumpur, Malaysia
,
Benedict Dhamaraj A.L. Retna Pandian
2   Thoracic Surgery Unit, Department of General Surgery, Hospital Kuala Lumpur, Jalan Pahang, Kuala Lumpur, Malaysia
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Abstract

Extensive chest wall tumor resection and reconstruction possess a formidable challenge and require good collaboration between thoracic and reconstructive surgeons. In this article, we reviewed our experience in six consecutive cases requiring complex chest wall resection and reconstruction with titanium rib plates and free anterolateral thigh fasciocutaneous flap with fascia lata with a minimum 24 months follow-up postoperatively.

Six patients with a mean age of 54 were diagnosed to have locally advanced malignant (n = 5) and benign (n = 1) tumors. They underwent wide local excision with a mean of six ribs resected, and the average size of the soft tissue defect was 389cm2. The integrity of the thoracic cage was restored by using titanium rib plates. Fascia lata was harvested along with free anterolateral thigh fasciocutaneous flap to achieve near airtight closure of pleural space for soft tissue coverage. Two patients required early flap exploration with successful flap salvage. One flap failure was reported on postoperative day 11 due to a mechanical cause and a redo surgery was required. With an average stay of 3 days in the intensive care unit, no perioperative pulmonary complications were recorded.

Complex oncological chest wall resection and reconstruction with titanium rib plates and free anterolateral thigh fasciocutaneous flap with fascia lata yielded satisfactory aesthetic and physiological functional outcomes.

Keywords

oncological chest wall reconstruction - anterolateral thigh flap - titanium rib plate


Publication History

Article published online:
21 February 2023

© 2023. Association of Plastic Surgeons of India. This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/)

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