Abstract：
BACKGROUND: A reconstructive option for extensive chest wall reconstruction is the free myocutaneous vastus lateralis muscle (VL) flap which can be performed in isolation or in conjunction with a fasciocutaneus anterolateral thigh (cVLALT) and/or myofasciocutaneous tensor fascia lata flap (cVLTFL). We aimed to directly compare the outcomes of these reconstructive options.
METHODS: Patients who underwent oncological chest wall reconstruction with a free VL, cVLALT, or cVLTFL flap between February 2010 and 2022 were included in this retrospective study. Patient demographics, surgical characteristics, as well as medical and reconstructive outcomes, were evaluated. The operative outcomes between myocutaneous VL, cVLALT, and cVLTFL flap reconstructions were compared.
RESULTS: A total of 41 patients underwent chest wall reconstruction with a free myocutaneous VL (n = 25; 61%), cVLALT (n = 14; 34%), or cVLTFL Three acute flap thromboses occurred in the entire cohort (3/41, 7%), with one myocutaneous VL flap failing because of recurrent venous thrombosis during the salvage procedure. Total flap necrosis was seen in two cases (5%; VL flap: n = 1; cVLALT flap: n = 1), and partial flap necrosis in one VL flap (1/25, 4%) and in the distal ALT portion of three cVLALT flaps (3/14, 21%). No significant difference was seen between isolated VL and conjoined VL flaps regarding the partial (p = .28) or total flap necrosis rate (p = .9).
CONCLUSIONS: The free (conjoined) VL flap provides reliable outcomes for obliterating dead space achieving durable reconstruction of complex chest wall defects.
METHODS: Patients who underwent oncological chest wall reconstruction with a free VL, cVLALT, or cVLTFL flap between February 2010 and 2022 were included in this retrospective study. Patient demographics, surgical characteristics, as well as medical and reconstructive outcomes, were evaluated. The operative outcomes between myocutaneous VL, cVLALT, and cVLTFL flap reconstructions were compared.
RESULTS: A total of 41 patients underwent chest wall reconstruction with a free myocutaneous VL (n = 25; 61%), cVLALT (n = 14; 34%), or cVLTFL Three acute flap thromboses occurred in the entire cohort (3/41, 7%), with one myocutaneous VL flap failing because of recurrent venous thrombosis during the salvage procedure. Total flap necrosis was seen in two cases (5%; VL flap: n = 1; cVLALT flap: n = 1), and partial flap necrosis in one VL flap (1/25, 4%) and in the distal ALT portion of three cVLALT flaps (3/14, 21%). No significant difference was seen between isolated VL and conjoined VL flaps regarding the partial (p = .28) or total flap necrosis rate (p = .9).
CONCLUSIONS: The free (conjoined) VL flap provides reliable outcomes for obliterating dead space achieving durable reconstruction of complex chest wall defects.
摘要：
背景：广泛的胸壁重建的一种重建选择是游离的肌皮肤股外侧肌（VL）皮瓣，可以单独进行，也可以与股前外侧筋膜（cVLALT）和/或肌筋膜肌筋膜肌筋膜肌筋膜筋膜瓣（cVLTFL）联合进行。我们旨在直接比较这些重建方案的结果。
方法：接受自由VL的肿瘤胸壁重建的患者，cVLALT,本回顾性研究包括2010年2月至2022年之间的cVLTFL皮瓣。患者人口统计学，手术特点,以及医疗和重建结果，进行了评估。肌皮VL，cVLALT,和cVLTFL皮瓣重建进行了比较。
结果：共有41例患者接受了游离肌皮VL的胸壁重建（n=25；61％），cVLALT（n=14；34%），或cVLTFL在整个队列中发生了三个急性皮瓣血栓形成（3/41，7％），在抢救过程中，由于反复的静脉血栓形成，一个肌皮瓣VL失败。2例（5%；VL皮瓣：n=1；cVLALT皮瓣：n=1），一个VL皮瓣（1/25，4％）和三个cVLALT皮瓣的远端ALT部分（3/14，21％）的部分皮瓣坏死。在部分（p=.28）或全部皮瓣坏死率（p=.9）方面，分离的VL和连体VL皮瓣之间没有显着差异。
结论：游离（连体）VL皮瓣为消除死腔提供了可靠的结果，可实现复杂胸壁缺损的持久重建。
方法：接受自由VL的肿瘤胸壁重建的患者，cVLALT,本回顾性研究包括2010年2月至2022年之间的cVLTFL皮瓣。患者人口统计学，手术特点,以及医疗和重建结果，进行了评估。肌皮VL，cVLALT,和cVLTFL皮瓣重建进行了比较。
结果：共有41例患者接受了游离肌皮VL的胸壁重建（n=25；61％），cVLALT（n=14；34%），或cVLTFL在整个队列中发生了三个急性皮瓣血栓形成（3/41，7％），在抢救过程中，由于反复的静脉血栓形成，一个肌皮瓣VL失败。2例（5%；VL皮瓣：n=1；cVLALT皮瓣：n=1），一个VL皮瓣（1/25，4％）和三个cVLALT皮瓣的远端ALT部分（3/14，21％）的部分皮瓣坏死。在部分（p=.28）或全部皮瓣坏死率（p=.9）方面，分离的VL和连体VL皮瓣之间没有显着差异。
结论：游离（连体）VL皮瓣为消除死腔提供了可靠的结果，可实现复杂胸壁缺损的持久重建。
