A Disaster and Salvage Revisited: Chest Wall Reconstruction (5-Rib Defect) With Gore-Tex, TRAM Flap, and Salvage With...

Area of Science:

• Oncology
• Plastic Surgery
• Surgical Innovation

Background:

• Recurrent desmoid tumors of the breast require aggressive surgical management, often resulting in significant chest wall defects.
• This case involved a large chest wall defect following resection of a recurrent desmoid tumor involving multiple ribs and the sternum.

Purpose of the Study:

• To describe the successful reconstruction of a complex chest wall defect using a TRAM flap over a Gore-Tex graft.
• To report the novel application of medicinal leeches to manage venous congestion in a TRAM flap, salvaging the reconstruction.

Main Methods:

• A TRAM flap was used to reconstruct a chest wall defect after wide resection of a recurrent desmoid tumor.
• Medicinal leech therapy was applied for 4 days to address venous congestion in the TRAM flap, with leeches applied directly to the congested tissue.
• Subsequent staged reconstruction included a pectoralis implant and bilateral breast implants.

Main Results:

• The TRAM flap initially provided adequate reconstruction but developed venous congestion within 18 hours post-surgery.
• Leech therapy effectively alleviated venous congestion, promoting blood flow and oxygen delivery through induced hemodilution.
• The reconstruction successfully protected the heart and lungs, and the desmoid tumor has not recurred.

Conclusions:

• Radical resection remains a primary management for desmoid tumors.
• Medicinal leech therapy can be an effective, albeit unconventional, method for salvaging myocutaneous flaps with venous congestion.
• This case highlights the successful use of leeches in plastic surgery to improve flap viability and patient outcomes.