Thoraxwandrekonstruktion bei fortgeschrittenen Tumoren der Brust

Zusammenfassung

Bei fortgeschrittenen Tumoren der Mamma werden oft ausgedehnte Resektionen, teilweise unter Mitnahme von Anteilen der Thoraxwand, nötig. Plastisch-chirurgische Rekonstruktionsverfahren bieten suffiziente Möglichkeiten, auch große Thoraxwanddefekte zu decken. Gestielte Lappenplastiken vom Rumpf, aber auch freie Lappenplastiken ermöglichen durch einen sicheren Defektverschluss die Entfernung großer, ulzerierter, schmerzhafter oder blutender Tumoren mit moderater Hebemorbidität. Der Einfluss der Thoraxwandteilresektion auf die Atemmechanik ist gut kompensierbar, die Lebensqualität der Patienten im oft palliativen Stadium der Erkrankung kann verbessert werden.

Abstract

In advanced mammary tumours, extensive resections, sometimes involving sections of the thoracic wall, are often necessary. Plastic surgery reconstruction procedures offer sufficient opportunities to cover even large thoracic wall defects. Pedicled flaps from the torso but also free flap-plasties enable, through secure defect closure, the removal of large, ulcerated, painful or bleeding tumours with moderate donor site morbidity. The impact of thoracic wall resection on the respiratory mechanism can be easily compensated for and patientsʼ quality of life in the palliative stage of disease can often be improved.

Schlüsselwörter

Fehlbildungen der Mamma - Mamma - Mammamalignom - Mammakarzinom

Key words

deformities of the breast - breast - breast cancer - breast carcinoma

• Literatur

• 1 Granick MS, Larson DL, Solomon MP. Radiation-related wounds of the chest wall. Clin Plast Surg 1993; 20: 559-571
• 2 Steinau HU, Hebebrand D, Vogt P et al. [Reconstructive plastic surgery of thoracic wall defects]. Chirurg 1997; 68: 461-468
• 3 Vogt PM, Busch K, Peter FW et al. [Plastic reconstruction of the irradiated thoracic wall]. Langenbecks Arch Chir Suppl Kongressbd 1998; 115: 507-511
• 4 Arnold PG, Pairolero PC. Chest-wall reconstruction: an account of 500 consecutive patients. Plast Reconstr Surg 1996; 98: 804-810
• 5 Losken A, Thourani VH, Carlson GW et al. A reconstructive algorithm for plastic surgery following extensive chest wall resection. Br J Plast Surg 2004; 57: 295-302
• 6 Chang RR, Mehrara BJ, Hu QY et al. Reconstruction of complex oncologic chest wall defects: a 10-year experience. Ann Plast Surg 2004; 52: 471-479 discussion 479
• 7 Chapelier A, Macchiarini P, Rietjens M et al. Chest wall reconstruction following resection of large primary malignant tumors. Eur J Cardiothorac Surg 1994; 8: 351-356 discussion 357
• 8 Koch H, Tomaselli F, Pierer G et al. Thoracic wall reconstruction using both portions of the latissimus dorsi previously divided in the course of posterolateral thoracotomy. Eur J Cardiothorac Surg 2002; 21: 874-878
• 9 Lardinois D, Müller M, Furrer M et al. Functional assessment of chest wall integrity after methylmethacrylate reconstruction. Ann Thorac Surg 2000; 69: 919-923
• 10 Bury TF, Reece GP, Janjan NA et al. Closure of massive chest wall defects after full-thickness chest wall resection. Ann Plast Surg 1995; 34: 409-414
• 11 Dieterich M, Dieterich H, Moch H et al. Re-excision rates and local recurrence in breast cancer patients undergoing breast conserving therapy. Geburtsh Frauenheilk 2012; 72: 1018-1023
• 12 Grischke E-M, Wallwiener D, Souchon R et al. Isolated loco-regional recurrence of breast cancer – established and innovative therapy concepts. Geburtsh Frauenheilk 2013; 73: 611-622
• 13 Ebner FK, Friedl TWP, deGregorio N et al. Does non-placement of a drain in breast surgery increase the rate of complications and revisions?. Geburtsh Frauenheilk 2013; 73: 1128-1134
• 14 Dieterich M, Faridi A. Biological matrices and synthetic meshes used in implant-based breast reconstruction – a review of products available in Germany. Geburtsh Frauenheilk 2013; 73: 1100-1106
• 15 Deschamps C, Tirnaksiz BM, Darbandi R et al. Early and long-term results of prosthetic chest wall reconstruction. J Thorac Cardiovasc Surg 1999; 117: 588-591 discussion 591–592
• 16 Kroll SS, Walsh G, Ryan B et al. Risks and benefits of using Marlex mesh in chest wall reconstruction. Ann Plast Surg 1993; 31: 303-306
• 17 Riedel K, Kremer T, Hoffmann H et al. [Plastic surgical reconstruction of extensive thoracic wall defects after oncologic resection]. Chirurg 2008; 79: 164-174
• 18 Saint-Cyr M, Wong C, Schaverien M et al. The perforasome theory: vascular anatomy and clinical implications. Plast Reconstr Surg 2009; 124: 1529-1544
• 19 Ariyan S. The pectoralis major myocutaneous flap. A versatile flap for reconstruction in the head and neck. Plast Reconstr Surg 1979; 63: 73-81
• 20 Daigeler A, Falkenstein A, Pennekamp W et al. Sternal osteomyelitis: long-term results after pectoralis muscle flap reconstruction. Plast Reconstr Surg 2009; 123: 910-917
• 21 Arnold PG, Pairolero PC. Use of pectoralis major muscle flaps to repair defects of anterior chest wall. Plast Reconstr Surg 1979; 63: 205-213
• 22 Jurkiewicz MJ, Bostwick 3rd J, Hester TR et al. Infected median sternotomy wound. Successful treatment by muscle flaps. Ann Surg 1980; 191: 738-744
• 23 Mathes SJ. Chest wall reconstruction. Clin Plast Surg 1995; 22: 187-198
• 24 Daigeler A, Simidjiiska-Belyaeva M, Drucke D et al. The versatility of the pedicled vertical rectus abdominis myocutaneous flap in oncologic patients. Langenbecks Arch Surg 2011; 396: 1271-1279
• 25 McCraw JB, Penix JO, Baker JW. Repair of major defects of the chest wall and spine with the latissimus dorsi myocutaneous flap. Plast Reconstr Surg 1978; 62: 197-206
• 26 Olivari N. The latissimus flap. Br J Plast Surg 1976; 29: 126-128
• 27 Schwabegger AH, Bodner G, Ninkovic M et al. Thoracodorsal artery perforator (TAP) flap: report of our experience and review of the literature. Br J Plast Surg 2002; 55: 390-395
• 28 Daigeler A, Druecke D, Hakimi M et al. Reconstruction of the thoracic wall-long-term follow-up including pulmonary function tests. Langenbecks Arch Surg 2009; 394: 705-715
• 29 Lee AB, Schimert G, Shaktin S et al. Total excision of the sternum and thoracic pedicle transposition of the greater omentum; useful strategems in managing severe mediastinal infection following open heart surgery. Surgery 1976; 80: 433-436
• 30 van Wingerden JJ, Lapid O, Boonstra PW et al. Muscle flaps or omental flap in the management of deep sternal wound infection. Interact Cardiovasc Thorac Surg 2011;
• 31 Milano CA, Georgiade G, Muhlbaier LH et al. Comparison of omental and pectoralis flaps for poststernotomy mediastinitis. Ann Thorac Surg 1999; 67: 377-380 discussion 380–381
• 32 Jurkiewicz MJ, Arnold PG. The omentum: an account of its use in the reconstruction of the chest wall. Ann Surg 1977; 185: 548-554
• 33 Hultman CS, Culbertson JH, Jones GE et al. Thoracic reconstruction with the omentum: indications, complications, and results. Ann Plast Surg 2001; 46: 242-249
• 34 Reichenberger MA, Harenberg PS, Pelzer M et al. Arteriovenous loops in microsurgical free tissue transfer in reconstruction of central sternal defects. J Thorac Cardiovasc Surg 2010; 140: 1283-1287
• 35 Fischer S, Klinkenberg M, Behr B et al. Comparison of donor-site morbidity and satisfaction between anterolateral thigh and parascapular free flaps in the same patient. J Reconstr Microsurg 2013; 29: 537-544
• 36 Klinkenberg M, Fischer S, Kremer T et al. Comparison of anterolateral thigh, lateral arm, and parascapular free flaps with regard to donor-site morbidity and aesthetic and functional outcomes. Plast Reconstr Surg 2013; 131: 293-302
• 37 al-Kattan KM, Breach NM, Kaplan DK et al. Soft-tissue reconstruction in thoracic surgery. Ann Thorac Surg 1995; 60: 1372-1375
• 38 Pfannschmidt J, Geisbusch P, Muley T et al. Surgical resection of secondary chest wall tumors. Thorac Cardiovasc Surg 2005; 53: 234-239
• 39 Tukiainen E, Popov P, Asko-Seljavaara S. Microvascular reconstructions of full-thickness oncological chest wall defects. Ann Surg 2003; 238: 794-801 discussion 801–802
• 40 Walsh GL, Davis BM, Swisher SG et al. A single-institutional, multidisciplinary approach to primary sarcomas involving the chest wall requiring full-thickness resections. J Thorac Cardiovasc Surg 2001; 121: 48-60
• 41 Mansour KA, Thourani VH, Losken A et al. Chest wall resections and reconstruction: a 25-year experience. Ann Thorac Surg 2002; 73: 1720-1725 discussion 1725–1726
• 42 Cohen M, Ramasastry SS. Reconstruction of complex chest wall defects. Am J Surg 1996; 172: 35-40
• 43 Wei FC, Jain V, Celik N et al. Have we found an ideal soft-tissue flap? An experience with 672 anterolateral thigh flaps. Plast Reconstr Surg 2002; 109: 2219-2226 discussion 2227–2230