Experience of Reconstruction of an Extensive Chest Wall Defect with Extended External Oblique Musculocutaneous Flap

Purpose: The resection of locally advanced or recurred breast cancers frequently result in large chest wall defects and it leads to a great challenges to cover. Generally simple skin grafts are not a practical option for patients because of their poor cosmetic appearance and prognosis. The latissimus dorsi and rectus abdominis musculocutaneous flap have traditionally been recommended for closure of these large defects. Though the cosmetic result of reconstruction using these flaps is often excellent, but has significant drawbacks. Therefore, we thought that chest wall reconstruction using the external oblique musculocutaneous flap can be an alternative method for extensive chest wall defect related to large, locally advanced breast carcinoma. Methods & Results: We present a case of a 50-year-old Korean female, refered to our department with a left breast tumor for 10 months. CT demonstrate a large tumor on the left anterior chest wall and multiple nodules of varying size in the cervical areas and liver. FDG-PET showed areas of hot uptake throughout the left chest wall, mediastinum and liver. Biopsy was consistent with invasive ductal carcinoma (Grade III). The initial tumor was considered inoperable, so a series of chemotherapy was initiated. Though the size of the breast mass was slightly decreased, the patient continued to suffer from purulent discharge, unpleasant odor and contact bleeding of the mass, the salvage mastectomy was performed. Conclusion: We could reconstruct $23{\times}16\;cm$ sized large chest wall defect, resulting from the resection of a locally advanced breast carcinoma, using an external oblique musculocutaneous flap successfully. Immediate postoperatively checked flap was healthy. Overall result was good without any significant complications and discharged 3 weeks after operation.

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