Large posterior chest wall defect reconstructed with a de-epithelised trans-thoracic TRAM flap

Area of Science:

• Plastic Surgery
• Thoracic Surgery
• Surgical Oncology

Background:

• Posterior chest wall defects, particularly near the midline, present significant reconstructive challenges.
• Addressing pleural cavity status and skeletal support is crucial before tissue coverage for functional and anatomical reconstruction.

Observation:

• A patient with an aggressive ossifying fibromyxoid tumor in the lower dorsal paraspinal region required extensive chest wall resection.
• The surgery resulted in a 15 x 10 cm defect involving five posterior ribs, necessitating immediate bony frame reconstruction.

Findings:

• A Goretex patch, combined with a de-epithelized myocutaneous pedicled transverse rectus abdominis myocutaneous (TRAM) flap transposed through the hemithorax, successfully reconstructed the defect.
• The patient demonstrated rapid recovery, with extubation on postoperative day 2 and discharge within 10 days.

Implications:

• This case highlights the utility of an intra-thoracic TRAM flap for posterior chest wall defect reconstruction.
• The technique is proposed as a specific indication for extensive defects when alternative reconstructive options are limited.