SOFT-TISSUE RECONSTRUCTION IN THORACIC-SURGERY

Background. Reconstructive techniques using omental and myocutaneous flaps are widely used in the treatment of infected sternotomy wounds. To illustrate their wider role in thoracic reconstruction, we have retrospectively reviewed our experience over the last 5 years. Methods. We used complex omental and myocutaneous naps in 30 patients: 19 men and 11 women with a mean age of 53 +/- 4 years (range, 43 to 75 years). In 18 patients, these techniques were used to provide soft-tissue cover after chest wall resection, and in 12 cases complex myocutaneous naps were used to obliterate chronic intrathoracic cavities. Rectus muscle was used in 11 of 24 muscle naps, and omentum was used in 12 cases. There were 23 rotational naps and seven free myocutaneous naps with microvascular anastomosis. Results. There were no operative deaths, and there were three complications. In 2 patients with infected lesions, loss of the free flap required subsequent revision. In 1 patient, infection developed underneath a prosthesis, which was treated with drainage and rib resection. In all other cases, the primary aim of the operation was achieved without complications. Conclusions. The vascularity of the omentum should encourage its wider use, especially when infection exists preoperatively. Excellent results can be achieved when using the rectus muscle as a complex myocutaneous nap. The use of free naps should be reserved for difficult cases and used only in the absence of infection.