Sonia Gaucher1,2,3, Filippo Lococo4, Claude Guinet5, Antonio Bobbio6, Pierre Magdeleinat6, Samir Bouam7, Jean-François Regnard8,6, Marco Alifano8,6. 1. Faculté de Médecine, Université Paris Descartes, Paris, France. sonia.gaucher@aphp.fr. 2. Service de Chirurgie Thoracique, AP-HP, Hôpitaux Universitaires Paris Centre, Hôpital Cochin, Paris, France. sonia.gaucher@aphp.fr. 3. Service de Chirurgie Générale, Plastique et Ambulatoire, AP-HP, Hôpitaux Universitaires Paris Centre, Hôpital Cochin, 27 Rue du Faubourg Saint-Jacques, 75 014, Paris, France. sonia.gaucher@aphp.fr. 4. Unit of Thoracic Surgery, Arcispedale Santa Maria Nuova-IRCCS, Reggio Emilia, Italy. 5. Service de Radiologie, AP-HP, Hôpitaux Universitaires Paris Centre, Hôpital Cochin, Paris, France. 6. Service de Chirurgie Thoracique, AP-HP, Hôpitaux Universitaires Paris Centre, Hôpital Cochin, Paris, France. 7. Département d'Information Médicale, AP-HP, Hôpitaux Universitaires Paris Centre, Hôpital Cochin, Paris, France. 8. Faculté de Médecine, Université Paris Descartes, Paris, France.
Abstract
BACKGROUND: Flap transposition is an infrequent but far from exceptional thoracic surgical procedure. The aim of this retrospective study was to report our experience in a referral unit of general thoracic surgery analyzing the early results after flap transposition. METHODS: We retrospectively analyzed the clinical records, surgical notes, and postoperative results of a cohort of patients who underwent flap transposition in our unit from November 2000 to February 2013. RESULTS: Overall, a surgical approach adopting flap reconstruction techniques was performed in 81 patients (54 males, 27 females) with a median age of 62 years (range 20-87). Flap transposition was necessary to reconstruct chest wall after resection for malignancy (27 patients), to repair intrathoracic viscera perforation (15 patients), and to fill residual cavities secondary to pulmonary/pleural infection (39 patients). A pedicle muscle flap was transposed in most of cases (64 pts, 79 %), while in the remaining 17 cases (11 %), an omental flap was used. There were no immediate postoperative complications, while three in-hospital deaths occurred due to respiratory or multiorgan failure. Among patients undergone flap transposition to fill a residual cavity, we observed a recurrent bronchopleural fistula in three patients (7.7 %); such patients were treated by repeat flap transposition (2 cases) and by repeat cavernostomy (1 case). CONCLUSION: Flap transposition may be indicated as part of a multimodal treatment for severely ill patients requiring complex thoracic surgery.
BACKGROUND:Flap transposition is an infrequent but far from exceptional thoracic surgical procedure. The aim of this retrospective study was to report our experience in a referral unit of general thoracic surgery analyzing the early results after flap transposition. METHODS: We retrospectively analyzed the clinical records, surgical notes, and postoperative results of a cohort of patients who underwent flap transposition in our unit from November 2000 to February 2013. RESULTS: Overall, a surgical approach adopting flap reconstruction techniques was performed in 81 patients (54 males, 27 females) with a median age of 62 years (range 20-87). Flap transposition was necessary to reconstruct chest wall after resection for malignancy (27 patients), to repair intrathoracic viscera perforation (15 patients), and to fill residual cavities secondary to pulmonary/pleural infection (39 patients). A pedicle muscle flap was transposed in most of cases (64 pts, 79 %), while in the remaining 17 cases (11 %), an omental flap was used. There were no immediate postoperative complications, while three in-hospital deaths occurred due to respiratory or multiorgan failure. Among patients undergone flap transposition to fill a residual cavity, we observed a recurrent bronchopleural fistula in three patients (7.7 %); such patients were treated by repeat flap transposition (2 cases) and by repeat cavernostomy (1 case). CONCLUSION:Flap transposition may be indicated as part of a multimodal treatment for severely ill patients requiring complex thoracic surgery.