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Multidisciplinary Oncoplastic Approach Reduces Infection in Chest Wall Resection and Reconstruction for Malignant
Haitham H Khalil1, Marco N Malahias1, Balapathiran Balasubramanian1
1Department of Oncoplasty and Reconstructive Surgery, Good Hope Hospital, Department of Breast Surgery, Solihull Hospital, and Departments of Radiology and Thoracic Surgery, Heartlands Hospital, Heart of England NHS Foundation Trust, Birmingham, United Kingdom; and Department of Orthopaedic Surgery, Royal Orthopaedic Hospital, Birmingham, United Kingdom. Part of this work has been presented as oral presentation and as invited speaker session in (1) 24th Annual Meeting for European Musculo-Skeletal Oncology Society (EMSOS), Ghent, 2011; (2) 32nd Annual Meeting for European Society of Surgical Oncology (ESSO), Valencia, 2012; (3) 29th Annual Meeting for European Association of Cardio-Thoracic Surgery (EACTS), Vienna, 2013; Annual Meeting for Society of Cardiothoracic Surgery of Great Britain and Ireland (SCTS) Edinburgh, 2014; and (5) Annual Meeting for Society of Cardiothoracic Surgery of Great Britain and Ireland (SCTS) Manchester, 2015.
Background:
Management of complex thoracic defects post tumor extipiration is challenging because of the nature of pathology, the radical approach, and the insertion of prosthetic material required for biomechanical stability. Wound complications pose a significant problem that can have detrimental effect on patient outcome. The authors outline an institutional experience of a multidisciplinary thoracic oncoplastic approach to improve outcomes.
Methods:
Prospectively collected data from 71 consecutive patients treated with chest wall resection and reconstruction were analyzed (2009-2015). The demographic data, comorbidities, operative details, and outcomes with special focus on wound infection were recorded. All patients were managed in a multidisciplinary approach to optimize perioperative surgical planning.
Results:
Pathology included sarcoma (78%), locally advanced breast cancer (15%), and desmoids (6%), with age ranging from 17 to 82 years (median, 42 years) and preponderance of female patients (n = 44). Chest wall defects were located anterior and anterolateral (77.5%), posterior (8.4%), and apical axillary (10%) with skeletal defect size ranging from 56 to 600 cm(2) (mean, 154 cm(2)). Bony reconstruction was performed using polyprolene mesh, methyl methacrylate prosthesis, and titanium plates. Soft tissue reconstructions depended on size, location, and flap availability and were achieved using regional, distant, and free tissue flaps. The postoperative follow-up ranged from 5 to 70 months (median, 32 months). All flaps survived with good functional and aesthetic outcome, whereas 2 patients experienced surgical site infection (2.8%).
Conclusions:
Multidisciplinary thoracic oncoplastic maximizes outcome for patients with large resection of chest wall tumors with reduction in surgical site infection and wound complications particularly in association with rigid skeletal chest wall reconstruction.
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