Journal of Postgraduate Medicine
 Open access journal indexed with Index Medicus & ISI's SCI  
Users online: 604  
Home | Subscribe | Feedback | Login 
About Latest Articles Back-Issues Article Submission Resources Sections Etcetera Contact
 
  NAVIGATE Here 
  Search
 
 :: Next article
 :: Previous article 
 :: Table of Contents
  
 RESOURCE Links
 ::  Similar in PUBMED
 ::  Search Pubmed for
 ::  Search in Google Scholar for
 ::Related articles
 ::  [PDF Not available] *
 ::  Citation Manager
 ::  Access Statistics
 ::  Reader Comments
 ::  Email Alert *
 ::  Add to My List *
* Registration required (free) 


  IN THIS Article
 ::  Introduction
 ::  Case report
 ::  Discussion
 ::  References

 Article Access Statistics
    Viewed8236    
    Printed92    
    Emailed4    
    PDF Downloaded0    
    Comments [Add]    

Recommend this journal


   
Year : 1987  |  Volume : 33  |  Issue : 1  |  Page : 37-8

Chest wall reconstruction by latissimus dorsi myocutaneous flap for breast cancer (a case report).







How to cite this article:
Bhathena H M, Shinde S R. Chest wall reconstruction by latissimus dorsi myocutaneous flap for breast cancer (a case report). J Postgrad Med 1987;33:37


How to cite this URL:
Bhathena H M, Shinde S R. Chest wall reconstruction by latissimus dorsi myocutaneous flap for breast cancer (a case report). J Postgrad Med [serial online] 1987 [cited 2019 Jul 16];33:37. Available from: http://www.jpgmonline.com/text.asp?1987/33/1/37/5303




  ::   Introduction Top

Local recurrence in breast cancer is not uncommon after primary surgery. The local disease is extremely painful to the patient especially when it has fungated out. One such case treated by excision of the chest wall and reconstruction using latissimus dorsi composite myocutaneous flap is presented.

  ::   Case report Top

ABC, a 30 year old unmarried young lady, underwent simple mastectomy in August 1979 for cancer of the left breast elsewhere. Following this, she was put on cyclophosphamide methotrexate and 5-fluorouracil (CMF) regimen of which she received 7 cycles. While she was on CMF, she developed local recurrence in the form of small nodules. Following this, she was given radiation therapy to the chest wall and peripheral glandular areas totalling 4500 rads. Following this, she was given one dose of cyclophosphamide-adriaycin and 5-fluorouracil (CAF) in the month of June 1980. After that, the patient was without any treatment till January 1984, at which time she had a huge fungating recurrent growth involving the whole of the chest wall [Fig. 1]. This growth was fixed to the ribs. She was given 3 cycles of CAF. In March 1984, a total skeletal survey, liver scintigraphy and lung tomograms were done. Having confirmed the fact that the disease was still localised to the chest wall, we decided to do a wide excision of the disease involving full thickness chest wall which resulted into a skin defect of 24 cm x 24 cm and a chest wall defect of 15 cm x 15 cm [Fig. 1C]. Defect in the bony cage was bridged with the help of a fascia lata free graft from the left thigh. Latissimus dorsi myocutaneous flap was raised and rotated to cover the defect [Fig. 1EF]. Two drains were kept and wound closed. The patient was followed up for one year. The results at this time are shown in [Fig. 2].

  ::   Discussion Top

Inadequate local treatment leads to a higher percentage of local recurrence in breast cancer. In fact, the aim of any local treatment either in the form of surgery or radiotherapy is to get a good loco-regional control than a longer survival. Since the concept of micrometastases came into work, the adjuvant treatment in the form of chemotherapy took its roots. Very often physicians mistake chemotherapy as a substitute for an inadequate local therapy and the results are as disastrous as this. No doubt, a local recurrence usually heralds a bad prognosis but not necessarily in all cases. In the absence of any evidence of a widespread disease, aggressive local treatment is justified, especially more so when the growing concept of quality of life is considered.
In this particular case, we have decided to use autogenous material especially because of the high chances of rejection of a foreign material. Review of the literature suggests that chest wall reconstruction has been a difficult problem.[4] The respiratory movements coupled with the need for stability make the problem more difficult. Use of bone flaps from the sternum, strips of ribs sutured in place with wire and periosteal flaps from the adjacent ribs are described. Winkel[6] and Watson and James[5] had reported use of fascia lata grafts.[3] Campbell[1] had combined the free fascia lata graft with transposed latissimus dorsi muscle and obtained skin over with a split skin graft.
Rigid foreign bodies such as tantalum plates and stainless steel mesh, were used unsuccessfully in the past as they loosen with respiratory movements, get infected and ultimately rejected. Metal mesh guaze is abandoned because of its tendency to fracture or disintegrate. Rigid support is important to prevent herniation of the lung and paradoxical movements. Case like this, following local radiation injury,[1-3] demands support and coverage by a well vascularized bulky flap to avoid paradoxical respiratory movements. This was provided by a latissimus dorsi myocutaneous flap with fascia lata graft. The bulk of the flap itself was enough to prevent the paradoxical movement.[2]

  ::   References Top

1.Campbell, D. A.: Reconstruction of the anterior thoracic wall. J. Thoracic Surg., 19: 456-461, 1950.  Back to cited text no. 1    
2.Mandelson, B. C. and Masson, J. K.: Treatment of chronic radiation injury over the shoulder with a latissimus dorsi myocutaneous flap. Plast. and Reconstruct. Surg., 60: 681-691, 1977.  Back to cited text no. 2    
3.May, J. W., Toth, B. A. and Cohen, A. M.: Teres major latissimus dorsi skin muscle flap for chest wall reconstruction. Plast. and Reconstr. Surg., 69: 326-328, 1982.  Back to cited text no. 3    
4.Stephenson, K. L. and Mosley, J. M.: Reconstructive problems of the chest and breast. Amer: J. Surg., 92: 26 36, 1956.  Back to cited text no. 4    
5.Watson, W. L. and James, A. G.: Fascia lata grafts for chest wall defects. J. Thorac. Surg., 16: 399-406, 1947.  Back to cited text no. 5    
6.Winkel, A. Ff.: Hernia of lung; Report of a case, outlining mode of fascia lata repair, J. Thoracic Surg., 4: 627-634, 1935.  Back to cited text no. 6    

Top
Print this article  Email this article
Previous article Next article
Online since 12th February '04
2004 - Journal of Postgraduate Medicine
Official Publication of the Staff Society of the Seth GS Medical College and KEM Hospital, Mumbai, India
Published by Wolters Kluwer - Medknow