B8
GAM 2014 BIARRITZ
DAST S, ASSAF N, BERNA P, DESSENA L, SINNA R.
Composite TDAP flap for complex thoracic reconstruction
Author
Sandy DAST, MD
Plastic Surgery Unit, University Hospital Amiens Nord, Amiens, France *
Email: s.dast@hotmail.fr
Co-Authors
N. ASSAF, MD *
P. BERNA, MD, PhD, Thoracic Surgery Unit, Amiens University Hospital, Amiens, France
L. DESSENA, MD *
R. SINNA, MD, PhD *
Abstract
Introduction
Sternal chondrosarcoma is rare and often requires total or subtotal sternectomy and
resection of this tumor can potentially cause a large anterior chest wall defect. The primary
goal of chest wall reconstruction after total or subtotal sternectomy is to maintain normal
respiration, restore chest wall stability, and ensure a cosmetically acceptable
reconstruction and decrease donor site morbidity.
Method
Our case report concern a 70-year-old man with sternoclavicular joint chondrosarcoma
who underwent subtotal sternectomy with partial resection of the two clavicles and
anterior arches of first to third right ribs. Anterior chest wall reconstruction was performed
with a composite thoracodorsal artery perforator free flap with sixth and seventh ribs
vascularized on serratus muscle.
Results
The patient was extubated on the first postoperative day. The postoperative course was
uneventful. Histology examination of the specimen confirmed the diagnosis of
chondrosarcoma with negative resection margins. Postoperative roentgenogram and
computed tomography showed good chest wall stability and no pulmonary complications.
Seven months after surgery, the patient was alive without recurrence with no functional
impairment and a satisfactory cosmetic result.
Conclusion
The composite thoracodorsal artery perforator free flap with vascularized ribs procedure
allows autologous reconstruction, provides satisfactory chest wall stability and good bone
graft integration due to the use of vascularized ribs, decreased donor site morbidity with
the latissimus dorsi left in place, and a satisfactory cosmetic result with a thin skin paddle.
This flap provides a new option for anterior chest wall reconstruction.
Keywords
Thorax, defects, flap, TDAP flap