[Repair of large upper thoracic wall defect after tumorectomy].

OBJECTIVE

To observe an early result after the repair of the large upper thoracic wall defect by a combined use of the titanium net, reconstruction nickelclad, and latissimus dorsi myocutaneous flap in a patient who underwent a breast sarcomatoid caricinoma resection on the upper thoracic wall.

METHODS

A breast sarcomatoid carcinoma in the upper thoracic wall was removed in 1 56-year-old female patient in February 2006. After the tumorectomy, a large thoracic wall defect was left, which was 20 cm X 15 cm in size. The defect was covered by the titanium net, the bilateral stumps of the clavicles were connected by the reconstruction nickelclad, and the soft tissue defect was repaired with the right latissimus dorsi myocutaneous flap (20 cm x 15 cm).

RESULTS

The patient depended on the breathing machine for 3 days after operation. When the breathing machine was discontinued, the patient developed a severe paradoxical breathing. Two weeks after operation when the blood circulation of the flap was stabilized, the paradoxical breathing disappeared with the help of the chest bandage for fixation of the chest cavity, and the blood supply of the flap was improved. The chest X-ray film showed that the titanium net and the reconstruction nickelclad were well positioned. The patient received chemotherapy 1 month after operation, The follow-up for 3 months revealed that the patient's local condition and physical condition were good, and ROM of both the shoulders was improved, with AF 90 degrees and ABD 90 degrees. No recurrence of the tumor was found.

CONCLUSION

A large thoracic wall defect should be repaired with solid materials. The normal anatomic locations of the clavicles should be maintained with fixation by the reconstruction nickelclad for a good function of the shoulders. The latissimus dorsi myocutaneous flap can be properly enlarged.