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da Costa Vieira RA, de Oliveira-Junior I, Branquinho LI, Haikel RL, Ching AW. Modified External Oblique Myocutaneous Flap for Repair of Postmastectomy Defects in Locally Advanced Breast Tumors: A Cohort Series Associated with a Systematic Review of Literature. Ann Surg Oncol 2020; 28:3356-3364. [PMID: 33063264 DOI: 10.1245/s10434-020-09205-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2020] [Accepted: 09/14/2020] [Indexed: 11/18/2022]
Abstract
BACKGROUND Locally advanced breast tumors (LABT) are situations of difficult resolution in clinical practice. External oblique myocutaneous flap (EOMF) is an option, but there are few studies in the literature on its use. METHODS This was a retrospective, cohort institutional study of patients with LABT who were undergoing mastectomy combined with the use of modified-EOMF (M-EOMF). Preoperative indications and conditions, factors associated with surgery, time to radiotherapy, local recurrence, and survival were assessed. A systematic review of the literature also was performed to evaluate the use of EOMF. RESULTS Over the 10-year period, 17 patients underwent M-EOMF closure. The mean duration of surgery was 251 min, and extensive skin area was resected (mean 468 ± 260 cm2). Four patients developed local recurrence. The actuarial survival at 36 months was 48.3%. Using PRISMA statement, among 115 articles evaluated from 3 databases, 8 articles were selected, in which 146 patients underwent EOMF. EOMF are associated with low postoperative complications with 8.9% skin necrosis. The M-EOMF allowed the resection of larger areas than other flaps described in the literature but is associated with skin necrosis. CONCLUSIONS M-EOMF has the advantages of not requiring a change in the patient's position for the closure of large areas. It is thus an acceptable option for chest wall reconstruction in tumors at the limit of resectability.
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Affiliation(s)
- René Aloisio da Costa Vieira
- Postgraduate Program of Oncology, Barretos Cancer Hospital, Barretos, SP, Brazil. .,Postgraduate Program Tocoginecology, Botucatu Medical School, Sao Paulo State University - UNESP, São Paulo, Brazil.
| | - Idam de Oliveira-Junior
- Postgraduate Program Tocoginecology, Botucatu Medical School, Sao Paulo State University - UNESP, São Paulo, Brazil.,Department of Mastology and Breast Reconstruction, Barretos Cancer Hospital, São Paulo, Brazil
| | | | - Raphael Luiz Haikel
- Department of Mastology and Breast Reconstruction, Barretos Cancer Hospital, São Paulo, Brazil
| | - An Wan Ching
- Department of Plastic Surgery, Federal University of São Paulo (UNIFESP), São Paulo, Brazil
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Repair and Reconstruction of Defects After Resection of Chest Wall and Abdominal Tumors. Plast Reconstr Surg 2018. [DOI: 10.1007/978-981-10-3400-8_16] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Lee S, Jung Y, Bae Y. Immediate chest wall reconstruction using an external oblique myocutaneous flap for large skin defects after mastectomy in advanced or recurrent breast cancer patients: A single center experience. J Surg Oncol 2017; 117:124-129. [PMID: 29082566 DOI: 10.1002/jso.24830] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2017] [Accepted: 07/04/2017] [Indexed: 11/07/2022]
Abstract
BACKGROUND AND OBJECTIVES We report 75 single-stage chest-wall reconstructions using ipsilateral external oblique myocutaneous flap (EOMCF) to cover the extensive skin defects following resection of advanced or recurrent breast tumours at the Pusan National University Hospital. METHODS Between January 2007 and October 2015, 75 women with advanced or recurred breast cancer who underwent extensive mastectomy with immediate chest wall reconstruction using EOMCF were reviewed retrospectively. RESULTS Mean age was 50.5 ± 9.8 years and mean follow-up period was 36.7 ± 25.1 months. A total of 59 patients (78.7%) had stage III disease and the remaining 16 patients (21.3%) had stage IV. Mean excised breast tissue weight was 687.6 ± 416.5 g (range, 120.3-2797.1 g). The mean chest wall skin defect covered with an EOMCF was 228.3 ± 168.1 cm2 and corresponded to an approximately 15 × 15 cm defect. Average operative time for reconstruction was <2 h. There were no major complications such as flap loss, full thickness skin necrosis, or surgical site infections. With respect to loco-regional recurrence, nine patients (12%) experienced recurrence. Among the 59 non-stage IV patients, loco-regional relapse occurred in five patients (8.5%). CONCLUSIONS EOMCF can effectively cover large chest wall defects with a few minor complications and reliable local disease control.
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Affiliation(s)
- Seokwon Lee
- Department of Surgery, Biomedical Research Institute, Pusan National University Hospital, Busan, Republic of Korea
| | - Younglae Jung
- Department of Surgery, Biomedical Research Institute, Pusan National University Hospital, Busan, Republic of Korea
| | - Youngtae Bae
- Department of Surgery, Biomedical Research Institute, Pusan National University Hospital, Busan, Republic of Korea
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Rotation arc of pedicled anterolateral thigh flap for abdominal wall reconstruction: How far can it reach? J Plast Reconstr Aesthet Surg 2015; 68:1417-24. [DOI: 10.1016/j.bjps.2015.06.010] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2015] [Revised: 05/18/2015] [Accepted: 06/12/2015] [Indexed: 11/21/2022]
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Ferreira P, Malheiro E, Choupina M, Pinho C, Barbosa R, Reis J, Amarante J. Gunshot Abdominal Wall Injury Reconstructed with an Innervated Latissimus Dorsi Free Flap. ACTA ACUST UNITED AC 2007; 63:691-5. [PMID: 17514056 DOI: 10.1097/01.ta.0000235293.80263.59] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Affiliation(s)
- Pedro Ferreira
- Department of Plastic Reconstructive and Aesthetic Surgery, Hospital de São João, Porto Medical School, Porto, Portugal.
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Kuge H, Kuzumoto Y, Morita T. Reconstruction of an extensive chest wall defect using an external oblique myocutaneous flap following resection of an advanced Breast carcinoma: Report or a case. Breast Cancer 2006; 13:364-8. [PMID: 17146164 DOI: 10.2325/jbcs.13.364] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
We reconstructed a large chest wall defect, resulting from the resection of a locally advanced breast carcinoma, using an external oblique myocutaneous flap. The patient, a 58-year-old Japanese woman, presented with an inoperable breast carcinoma (Stage IV). Combination chemotherapy with cyclophosphamide (CPA) and epirubicin hydrochloride (EPI) resulted in a reduction in size of both the primary tumor and the metastatic lesions. However, the patient continued to experience purulent discharge accompanied by an unpleasant odor, as well as contact bleeding from the residual breast lesion. To address these complaints, we removed much of the remaining tumor surgically. The resulting skin defect measured 440 cm(2) and was covered using an external oblique myocutaneous flap. The patient's postoperative course was excellent, and she was still alive and well after 40 months of chemotherapy. This case is a demonstration of the effectiveness of the external oblique myocutaneous flap for the coverage of large ipsilateral chest wall defects.
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Affiliation(s)
- Hiroyuki Kuge
- Department of Surgery, Kouseikai Takai Hospital, Nara, Japan.
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Feijóo L, Martín M, Villarreal C, Lomas M, Gómez F. Reconstrucción de pared abdominal inferior usando el colgajo miocutáneo tensor de la fascia lata. Cir Esp 2002. [DOI: 10.1016/s0009-739x(02)71923-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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8
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Bogossian N. A new extended external oblique musculocutaneous flap for reconstruction of large chest-wall defects. Plast Reconstr Surg 2000; 105:473-5. [PMID: 10627026 DOI: 10.1097/00006534-200001000-00090] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Maas SM, van Engeland M, Leeksma NG, Bleichrodt RP. A modification of the "components separation" technique for closure of abdominal wall defects in the presence of an enterostomy. J Am Coll Surg 1999; 189:138-40. [PMID: 10401752 DOI: 10.1016/s1072-7515(99)00067-8] [Citation(s) in RCA: 53] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Affiliation(s)
- S M Maas
- Department of Surgery, University Hospital Vrije Universiteit, Amsterdam, The Netherlands
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Sasaki K, Nozaki M, Nakazawa H, Kikuchi Y, Huang T. Reconstruction of a large abdominal wall defect using combined free tensor fasciae latae musculocutaneous flap and anterolateral thigh flap. Plast Reconstr Surg 1998; 102:2244-52. [PMID: 9811028 DOI: 10.1097/00006534-199811000-00067] [Citation(s) in RCA: 56] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
A large abdominal wall defect was reconstructed with the use of a flap combining the tensor fasciae latae musculocutaneous flap and the anterolateral thigh flap in four individuals who had undergone extensive abdominal wall resection because of cancer. The flap was harvested as a single combined composite flap and was transferred to the recipient site by means of microvascular surgery. Morbidity was minimal and the outcome was satisfactory in all instances.
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Affiliation(s)
- K Sasaki
- Department of Plastic and Reconstructive Surgery at Tokyo Women's Medical College, Japan
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Williams JK, Carlson GW, deChalain T, Howell R, Coleman JJ. Role of tensor fasciae latae in abdominal wall reconstruction. Plast Reconstr Surg 1998; 101:713-8. [PMID: 9500388 DOI: 10.1097/00006534-199803000-00020] [Citation(s) in RCA: 122] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
The role of the tensor fasciae latae as autogenous tissue in reconstruction of abdominal wall defects is well established. The use of various forms of the tensor fasciae latae (free graft versus pedicled flap versus free flap) is determined by the characteristics of the defect. A review of abdominal wall reconstructions using tensor fasciae latae was completed to determine efficacy and establish guidelines for its use. Abdominal wall reconstructions from 1991 to 1994 using tensor fasciae latae were reviewed. Demographics, wound characteristics, and complications were evaluated. Twenty-seven patients with a mean follow-up of 23.6 months underwent abdominal wall reconstruction with the tensor fasciae latae: free grafts, 12; pedicled flaps, 9; and free flaps, 6. An average defect size of 14.4 x 13.1 cm was seen. Fourteen (52 percent) of the reconstructions were completed in contaminated or infected wounds. One recurrent enteric fistula was seen. Twelve (44 percent) of the patients had flap complications of which 50 percent involved partial flap necrosis. Donor site complications were seen in five patients (18 percent) and included a hematoma, seroma, and two cases of skin graft dehiscence along the edge of the wound. Tensor fasciae latae free grafts are an option for repair of abdominal hernias if abdominal soft tissue is adequate. Pedicled flaps may be used for defects of soft tissue and fascia but are limited by the arc of rotation and size of the defect. Tensor fasciae latae free flaps are versatile in orientation and may be used for supraumbilical defects. Tip necrosis is significant in both types of vascularized flaps.
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Affiliation(s)
- J K Williams
- Department of Surgery (Winship Oncology Clinic) at Emory University, Atlanta, Ga., USA
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Safak T, Klebuc MJ, Kecik A, Shenaq SM. Closure of upper extremity soft-tissue defects using the new "supra-crest" fasciocutaneous free flap. Plast Reconstr Surg 1997; 99:1154-9. [PMID: 9091919 DOI: 10.1097/00006534-199704000-00039] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
A fasciocutaneous island (15 x 10 cm) can be elevated from the inferolateral abdominal wall in a region encompassing the iliac crest and extending to the lower costal margin. This new fasciocutaneous flap was named the "supra-crest flap," in accordance with its anatomic location and vascular pattern. The blood supply stems from the direct cutaneous branches of the lumbar arteries (L2-3), which pierce the abdominal musculature approximately 2.0 cm above the iliac crest in the midaxillary line. The arteries and two vena comitantes have an average external diameter of 2.0 mm, and their dissection can be extended deep into the iliac fosa to provide a pedicle 8 or more cm in length. Two cutaneous nerves accompany the lumbar arteries, furnishing the possibility of a sensate flap. These structures have been transferred as a free flap with the donor site concealed by conventional underwear and bathing suits. Additionally, this region could be harvested as an island flap wherein the arc of rotation may be sufficient to cover defects of the thoracic wall and lumbosacral regions.
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Affiliation(s)
- T Safak
- Division of Plastic Surgery, Baylor College of Medicine, Houston, Texas, USA
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The reversed dermal graft concept in abdominal wall reconstruction. EUROPEAN JOURNAL OF PLASTIC SURGERY 1997. [DOI: 10.1007/bf01152187] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Abstract
The presence of a consistent subcutaneous vascular plexus allows carrying of a distal skin island safely on the iliotibial tract. A distal skin island can be designed on the lateral thigh and can be raised on a subcutaneous pedicle that is proximally supplied by the lateral femoral circumflex artery. This technique preserves the lateral thigh skin and employs subcutaneous tunneling to overcome the traditional drawbacks of the conventional extended tensor fascia lata flap. The subcutaneous pedicle tensor fascia lata flap's sensate potential, thin skin, durable fascia, extensive reach, and 360 degree arc of rotation make it an appealing donor site for coverage of lower midsection and pelvic defects or for penile reconstruction.
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Affiliation(s)
- T Safak
- Division of Plastic Surgery, Baylor College of Medicine, USA
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Bogossian N, Chaglassian T, Rosenberg PH, Moore MP. External oblique myocutaneous flap coverage of large chest-wall defects following resection of breast tumors. Plast Reconstr Surg 1996; 97:97-103. [PMID: 8532811 DOI: 10.1097/00006534-199601000-00016] [Citation(s) in RCA: 39] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
Defects resulting from resection of advanced breast tumors can be quite large, posing a difficult reconstructive challenge. A significant number of such patients present with local recurrences after receiving external beam radiation and/or chemotherapy treatments. Pectoralis major, latissimus dorsi, rectus abdominis, and omental flaps with split-thickness skin grafts have been recommended for closure of chest-wall defects. What is often excluded from the list of reconstructive options is the external oblique myocutaneous flap. In our series of 20 consecutive patients treated at Memorial Sloan-Kettering Cancer Center, an external oblique myocutaneous flap was used to cover these large chest-wall defects successfully. The median age of our patient population was 54.5 years, and 68 percent of them presented with local recurrence. Fifty percent had external beam radiation, and fifty percent had received chemotherapy. Twenty-five percent of our study group had had both treatments. The mean chest-wall defect measured 326 cm2, corresponding to a 20 x 16 cm area. We believe that the external oblique myocutaneous flap should be considered a safe and reliable option when reconstruction of large chest-wall defects is contemplated.
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Affiliation(s)
- N Bogossian
- Division of Plastic and Reconstructive Surgery, New York Hospital-Cornell University Medical College, N.Y., USA
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Sakai S, Soeda S, Matsukawa A. External oblique musculocutaneous flap for the reconstruction of a lumbo-sacral defect. BRITISH JOURNAL OF PLASTIC SURGERY 1988; 41:551-3. [PMID: 3179601 DOI: 10.1016/0007-1226(88)90017-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
This report describes a case of lumbo-sacral radiation ulcer which was treated successfully by an external oblique musculocutaneous flap supplied mainly by the subcostal artery.
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Affiliation(s)
- S Sakai
- Unit of Plastic Surgery, University of Tsukuba, Japan
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Sando W, Jurkiewicz MJ. An approach to repair of radiation necrosis of chest wall and mammary gland. World J Surg 1986; 10:206-19. [PMID: 3518251 DOI: 10.1007/bf01658137] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
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Stone HH, Fabian TC, Turkleson ML, Jurkiewicz MJ. Management of acute full-thickness losses of the abdominal wall. Ann Surg 1981; 193:612-8. [PMID: 6263197 PMCID: PMC1345130 DOI: 10.1097/00000658-198105000-00011] [Citation(s) in RCA: 158] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
Over a 20-year interval, 167 patients sustained acute full-thickness abdominal wall loss due to necrotizing infection (124 patients), destructive trauma (32 patients), or en bloc tumor excision (11 patients). Polymicrobial infection or contamination was present in all but five of the patients. Of 13 patients managed by debridement and primary closure under tension, abdominal wall dehiscence occurred in each. Only two patients survived, the 11 deaths being caused by wound sepsis, evisceration, and/or bowel fistula. Debridement and gauze packing of a small defect was used in 15 patients; the single death resulted from recurrence of infectious gangrene. Pedicled flap closure, with or without a fascial prosthesis beneath, led to survival in nine of the 12 patients so-treated; yet flap necrosis from infection was a significant complication in seven patients who survived. The majority of patients (124) were managed by debridements, insertions of a fascial prostheses (prolene in 101 patients, marlex in 23 patients), and alternate day dressing changes, until the wound could be closed by skin grafts placed directly on granulations over the mesh or the bowel itself after the mesh had been removed. Sepsis and/or intestinal fistulas accounted for 25 of the 27 deaths. Major principles to evolve from this experience were: 1) insertion of a synthetic prosthesis to bridge any sizeable defect in abdominal wall rather than closure under tension or via a primarily mobilized flap; 2) use of end bowel stomas rather than exteriorized loops or primary anastomoses in the face of active infection, significant contamination, and/or massive contusion; and 3) delay in final reconstruction until all intestinal vents and fistulas have been closed by prior operation.
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Hodgkinson DJ, Arnold PG. Chest-wall reconstruction using the external oblique muscle. BRITISH JOURNAL OF PLASTIC SURGERY 1980; 33:216-20. [PMID: 6446340 DOI: 10.1016/0007-1226(80)90014-4] [Citation(s) in RCA: 30] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
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Wilson JS, Rayner CR. The repair of large full-thickness post-excisional defects of the abdominal wall. BRITISH JOURNAL OF PLASTIC SURGERY 1974; 27:117-24. [PMID: 4275911 DOI: 10.1016/0007-1226(74)90001-0] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
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