Techniques in the composite reconstruction of extensive thoracoabdominal tumor resections

This report illustrates the unique problems of reconstructing thoracoabdominal wall defects coexisting with diaphragmatic defects.

Two patients with extensive primary chest wall tumors (chondrosarcoma and desmoid tumor) underwent aggressive resection of the hemithorax, hemidiaphragm, and anterior chest wall for cure. The combined chest and abdominal wall defect was greater than 625 cm2 in both cases.

Functional restoration of these massive thoracoabdominal defects was accomplished by use of polypropylene-methyl methacrylate prostheses and vascularized tissue coverage. The requirements for rigidity, protection, and esthetic contouring of the chest wall are satisfied by this reconstruction. This technique also offers the flexibility and durability that the abdominal wall requires. Repair of the diaphragm using this technique is secure and simple.

Our report confirms the principle that, with modern thoracic and plastic operative techniques, the extent of tumor resection should not be compromised because of concern over the ability to reconstruct the defect.