Multidisciplinary oncoplastic approach to chest wall reconstruction following wide resections. Report of three cases

Abstract

An advanced cancer or an infection process localized on chest wall often require large full thickness resection to obtain free margins and site sterilization.

Superior skills and expertise can be provided by a multidisciplinary surgical team, overcoming technical difficulties otherwise insurmountable for a single specialist. Only a multidisciplinary approach, providing both skeletal reconstruction and soft tissue coverage, allows to restore chest wall functions and stable coverage of lung and viscera. Furthermore, in case of lung exposition, immediate reconstructive procedure is demanded for stable coverage.

We present 3 complex clinical cases, in which an immediate plastic reconstruction followed a wide resection of thoracic wall, performed by combining synthetic or biologic mesh with large myocutaneous flaps.

Meticulous pre-op planning of every step, integration of reconstructive modalities proper of different specialties, and full cooperation among surgical teams are the backbone of such complex surgery.

The goals consist in reaching margins free of disease and fast healing, so reducing recovery time and promoting an immediate respiratory rehabilitation.

The clinical results of this report supports the importance of multidisciplinary approach in wide chest wall resections.