Thoracic Wall Reconstruction with Thoracoabdominal Flap

Abstract

Reconstructing the chest wall following substantial surgical removal is a challenging task for thoracic, oncologic, and reconstructive surgeons. Common indications include breast cancer, radionecrosis, and malignancies affecting fascia, muscle, and sometimes the ribs. Skin grafts are not a favorable choice due to their thinness and unsuitability of the recipient site. Over the past 30 years, a wide range of flaps have been created to achieve sufficient covering and protection of intrathoracic structures.The Tai and Hasegawa technique, developed in 1974, involves using a transverse fasciocutaneous flap taken from the same side of the body in the thoracoabdominal region. Davis and McCraw made modifications to this technique in 1977, and Brown and Vasconez in 1975 revealed the presence of musculocutaneous perforator branches originating from subcostal, intercostal, and lumbar arteries. Baroudi introduced a contralateral thoracoabdominal fasciocutaneous flap in 1978.In the 1980s, muscular and musculocutaneous flaps became widely accepted as the best method for reconstructing the chest wall. However, there have been limited comparison studies published, making it difficult to determine whether musculocutaneous flaps are preferable than fasciocutaneous flaps. Deo et al. (2019) proposed that the fasciocutaneous "thoracoabdominal" flap should be considered as the primary choice.The extended cutaneous thoracoabdominal flap is a straightforward and efficient surgery that can be completed in a single step. It is generally safe and rarely results in tissue death, and its generous mobility and "back-cut" incision facilitate advancement and rotation. However, it has drawbacks such as the inability to carry out an instant breast reconstruction and the presence of lengthy scars on the abdominal wall.