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Indications and Results of Reconstructive Techniques with Flaps Transposition in Patients Requiring Complex Thoracic Surgery: A 12-Year Experience

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Abstract

Background

Flap transposition is an infrequent but far from exceptional thoracic surgical procedure. The aim of this retrospective study was to report our experience in a referral unit of general thoracic surgery analyzing the early results after flap transposition.

Methods

We retrospectively analyzed the clinical records, surgical notes, and postoperative results of a cohort of patients who underwent flap transposition in our unit from November 2000 to February 2013.

Results

Overall, a surgical approach adopting flap reconstruction techniques was performed in 81 patients (54 males, 27 females) with a median age of 62 years (range 20–87). Flap transposition was necessary to reconstruct chest wall after resection for malignancy (27 patients), to repair intrathoracic viscera perforation (15 patients), and to fill residual cavities secondary to pulmonary/pleural infection (39 patients). A pedicle muscle flap was transposed in most of cases (64 pts, 79 %), while in the remaining 17 cases (11 %), an omental flap was used. There were no immediate postoperative complications, while three in-hospital deaths occurred due to respiratory or multiorgan failure. Among patients undergone flap transposition to fill a residual cavity, we observed a recurrent bronchopleural fistula in three patients (7.7 %); such patients were treated by repeat flap transposition (2 cases) and by repeat cavernostomy (1 case).

Conclusion

Flap transposition may be indicated as part of a multimodal treatment for severely ill patients requiring complex thoracic surgery.

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References

  1. Abrashanoff G (1911) Plastiche method der Schliessung von Fistelgangen, welche von inneren organen kommen. Zentralbl Chir 38:186–187

    Google Scholar 

  2. Arnold PG, Pairolero PC (1989) Intrathoracic muscle flaps: a 10-year experience in the management of life-threatening infections. Plast Reconstr Surg 84:92–98

    Article  CAS  PubMed  Google Scholar 

  3. Widmer MK, Krueger T, Lardinois D, Banic A, Ris HB (2000) A comparative evaluation of intrathoracic latissimus dorsi and serratus anterior muscle transposition. Eur J Cardiothorac Surg 18:435–439

    Article  CAS  PubMed  Google Scholar 

  4. Li EN, Goldberg NH, Slezak S, Silverman RP (2004) Split pectoralis major flaps for mediastinal wound coverage: a 12-year experience. Ann Plast Surg 53:334–337

    Article  PubMed  Google Scholar 

  5. Tosson R, Peter FW, Steinau HU, Vogt P (2004) Muscle and myocutaneous flaps in reconstructive surgery of thoracic defects. Heart Lung Circ 13:399–402

    Article  CAS  PubMed  Google Scholar 

  6. Okuda M, Yokomise H, Muneuchi G, Ishikawa S (2009) Obliteration of empyema space by vascularized anterolateral thigh flaps. Ann Thorac Surg 87:1615–1616

    Article  PubMed  Google Scholar 

  7. Botianu PV, Dobrica AC, Butiurca A, Botianu AM (2010) Complex space-filling procedures for intrathoracic infections—personal experience with 76 consecutive cases. Eur J Cardiothorac Surg 37:478–481

    PubMed  Google Scholar 

  8. Botianu PV, Botianu AM, Bacarea V, Dobrica AC (2010) Thoracodorsal versus reversed mobilisation of the latissimus dorsi muscle for intrathoracic transposition. Eur J Cardiothorac Surg 38:461–465

    Article  PubMed  Google Scholar 

  9. Botianu PV, Botianu AM, Dobrica AC, Bacarea V (2010) Intrathoracic transposition of the serratus anterior muscle flap—personal experience with 65 consecutive patients. Eur J Cardiothorac Surg 38:669–673

    Article  PubMed  Google Scholar 

  10. Takanari K, Kamei Y, Toriyama K, Yagi S, Torii S (2010) Management of postpneumonectomy empyema using free flap and pedicled flap. Ann Thorac Surg 89:321–323

    Article  PubMed  Google Scholar 

  11. Walsh MD, Bruno AD, Onaitis MW et al (2011) The role of intrathoracic free flaps for chronic empyema. Ann Thorac Surg 91:865–868

    Article  PubMed  Google Scholar 

  12. Manley K, Gelvez S, Meldon CJ, Levai I, Malata CM, Coonar AS (2013) Free deep inferior epigastric perforator flap used for management of post-pneumonectomy space empyema. Ann Thorac Surg 95:e83–e85

    Article  PubMed  Google Scholar 

  13. Mathisen DJ, Grillo HC, Vlahakes GJ, Daggett WM (1988) The omentum in the management of complicated cardiothoracic problems. J Thorac Cardiovasc Surg 95:677–684

    CAS  PubMed  Google Scholar 

  14. Regnard JF, Alifano M, Puyo P, Fares E, Magdeleinat P, Levasseur P (2000) Open window thoracostomy followed by intrathoracic flap transposition in the treatment of empyema complicating pulmonary resection. J Thorac Cardiovasc Surg 120:270–275

    Article  CAS  PubMed  Google Scholar 

  15. Grillo HC, Wilkins EW Jr (1975) Esophageal repair following late diagnosis of intrathoracic perforation. Ann Thorac Surg 20:387–399

    Article  CAS  PubMed  Google Scholar 

  16. Michel L, Grillo HC, Malt RA (1981) Operative and nonoperative management of esophageal perforations. Ann Surg 194:57–63

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  17. Gouge TH, Depan HJ, Spencer FC (1989) Experience with the Grillo pleural wrap procedure in 18 patients with perforation of the thoracic oesophagus. Ann Surg 209:612–617

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  18. Kotzampassakis N, Christodoulou M, Krueger T, Demartines N, Vuillemier H, Cheng C et al (2009) Esophageal leaks repaired by a muscle onlay approach in the presence of mediastinal sepsis. Ann Thorac Surg 88:966–972

    Article  PubMed  Google Scholar 

  19. Alifano M, Gaucher S, Rabbat A et al (2012) Alternatives to resectional surgery for infectious disease of the lung: from embolization to thoracoplasty. Thorac Surg Clin 22:413–429

    Article  PubMed  Google Scholar 

  20. Stefani A, Jouni R, Alifano M et al (2011) Thoracoplasty in the current practice of thoracic surgery: a single-institution 10-year experience. Ann Thorac Surg 91:263–269

    Article  PubMed  Google Scholar 

  21. Chirica M, Champault A, Dray X, Sulpice L, Munoz-Bongrand N, Sarfati E et al (2010) Esophageal perforation. J Visc Surg 147:e117–e128

    Article  CAS  PubMed  Google Scholar 

  22. Altorjay A, Kiss J, Vörös A, Bohak A (1997) Nonoperative management of oesophageal perforations. Is it justified? Ann Surg 225:415–421

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  23. Krassas A, Grima R, Bagan P et al (2010) Current indications and results for thoracoplasty and intrathoracic muscle transposition. Eur J Cardiothorac Surg 37:1215–1220

    Article  PubMed  Google Scholar 

  24. Massera F, Robustellini M, Pona CD, Rossi G, Rizzi A, Rocco G (2006) Predictors of successful closure of open window thoracostomy for pneumonectomy empyema. Ann Thorac Surg 82:288–292

    Article  PubMed  Google Scholar 

  25. Belmahi A, Ouezzani S (2008) El Aziz S [Muscular flaps and reconstructive surgery of empyema: about 12 cases]. Ann Chir Plast Esthet 53:1–8

    Article  CAS  PubMed  Google Scholar 

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Acknowledgments

We thank Madame Dominique Hervault & Monsieur Lionel Poursac for their precious technical assistance.

Author information

Author notes

    Authors and Affiliations

    1. Faculté de Médecine, Université Paris Descartes, Paris, France

      Sonia Gaucher, Jean-François Regnard & Marco Alifano

    2. Service de Chirurgie Thoracique, AP-HP, Hôpitaux Universitaires Paris Centre, Hôpital Cochin, Paris, France

      Sonia Gaucher, Antonio Bobbio, Pierre Magdeleinat, Jean-François Regnard & Marco Alifano

    3. Service de Chirurgie Générale, Plastique et Ambulatoire, AP-HP, Hôpitaux Universitaires Paris Centre, Hôpital Cochin, 27 Rue du Faubourg Saint-Jacques, 75 014, Paris, France

      Sonia Gaucher

    4. Unit of Thoracic Surgery, Arcispedale Santa Maria Nuova-IRCCS, Reggio Emilia, Italy

      Filippo Lococo

    5. Service de Radiologie, AP-HP, Hôpitaux Universitaires Paris Centre, Hôpital Cochin, Paris, France

      Claude Guinet

    6. Département d’Information Médicale, AP-HP, Hôpitaux Universitaires Paris Centre, Hôpital Cochin, Paris, France

      Samir Bouam

    Authors
    1. Sonia Gaucher
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    2. Filippo Lococo
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    Corresponding author

    Correspondence to Sonia Gaucher.

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    None of the authors have any financial interests to disclose.

    Additional information

    Jean-François Regnard and Marco Alifano have contributed equally to this work.

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    Cite this article

    Gaucher, S., Lococo, F., Guinet, C. et al. Indications and Results of Reconstructive Techniques with Flaps Transposition in Patients Requiring Complex Thoracic Surgery: A 12-Year Experience. Lung 194, 855–863 (2016). https://doi.org/10.1007/s00408-016-9921-0

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    • DOI: https://doi.org/10.1007/s00408-016-9921-0

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