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Thoracic wall reconstruction using both portions of the latissimus dorsi previously divided in the course of posterolateral thoracotomy

Koch, Horst ; Tomaselli, F. ; Pierer, G. ; Schwarzl, F. ; Haas, F. ; Smolle-Jüttner, F.M. ; Scharnagl, E.

In: European Journal of Cardio-Thoracic Surgery, 2002, vol. 21, no. 5, p. 874-878

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    Titre
    • Thoracic wall reconstruction using both portions of the latissimus dorsi previously divided in the course of posterolateral thoracotomy
    Auteur
    • Koch, Horst. Division of Plastic Surgery, Department of Surgery, Karl-Franzens University, Auenbruggerplatz 29, A-8036 Graz, Austria
    • Tomaselli, F.. Division of Thoracic and Hyperbaric Surgery, Department of Surgery, Karl-Franzens University, Graz, Austria
    • Pierer, G.. Department of Plastic and Reconstructive Surgery, University of Basel, Basel, Switzerland
    • Schwarzl, F.. Division of Plastic Surgery, Department of Surgery, Karl-Franzens University, Auenbruggerplatz 29, A-8036 Graz, Austria
    • Haas, F.. Division of Plastic Surgery, Department of Surgery, Karl-Franzens University, Auenbruggerplatz 29, A-8036 Graz, Austria
    • Smolle-Jüttner, F.M.. Division of Thoracic and Hyperbaric Surgery, Department of Surgery, Karl-Franzens University, Graz, Austria
    • Scharnagl, E.. Division of Plastic Surgery, Department of Surgery, Karl-Franzens University, Auenbruggerplatz 29, A-8036 Graz, Austria
    Type de document
    • Postprint
    Langue
    • Anglais
    Publié dans
    • European Journal of Cardio-Thoracic Surgery, 2002, vol. 21, no. 5, p. 874-878. Elsevier Science B.V.
    Autre version électronique
    Identifiant OAI-PMH
    • oai:doc.rero.ch:289538
    Summary
    Objective: Besides other factors, the choice of reconstructive method for full thickness thoracic wall defects depends on the morbidity of preceding surgical procedures. The pedicled latissimus dorsi flap is a reliable and safe option for reconstruction of the thorax. A posterolateral thoracotomy, however, results in division of the muscle. Both parts of the muscle can be employed to close full thickness defects of the chest wall. The proximal part can be pedicled on the thoracodorsal vessels or the serratus branch; the distal part can be pedicled on paravertebral or intercostal perforators. This retrospective study was undertaken to evaluate the reconstructive potential of both parts of the latissimus dorsi in thoracic wall reconstruction after posterolateral thoracotomy. Methods: Between 1987 and 1999, 36 consecutive patients underwent reconstruction of full-thickness thoracic wall defects with latissimus dorsi-flaps after posterolateral thoracotomies. The defects resulted from infection and open window thoracostomy (n=31), trauma (n=3) and resection of tumours (n=2). The patients' average age was 57 years (range 22-76 years). Twenty-five patients were male, 11 were female. In 31 cases the split latissimus dorsi alone was employed; in five cases additional flaps had to be used due to the size of the defects, additional intrathoracic problems or neighbouring defects. Results: In 34 cases defect closure could be achieved without major complications. Empyema recurred in the pleural cavity in one case and one patient died of septicaemia. The 15 patients who had required a respirator in the preoperative phase could be extubated 4.8 days (average) after thoracic wall reconstruction. Postoperative hospital stay averaged 16 days. Conclusions: Different methods are available for reconstruction of full thickness defects of the thoracic wall. After posterolateral thoracotomy in the surgical treatment of empyema, oncologic surgery and traumatology, the latissimus dorsi muscle still retains some reconstructive potential. Advantages are low additional donor site morbidity and anatomical reliability. As it is located near the site of the defect, there is no need for additional surgical sites or intraoperative repositioning. In our service, the split latissimus dorsi muscle flap has proven to be a valuable and reliable option in thoracic wall reconstruction