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Asian Cardiovasc Thorac Ann 2002;10:285-286
© 2002 Asia Publishing EXchange Pte Ltd

HOW TO DO IT

Reappraisal of Fascia Lata Grafts for Reconstruction of Chest Wall Defects

Tomohiro Murakawa, MD, Jun Nakajima, MD, Katsuhide Maeda, MD, Makoto Tanaka, MD, Shinichi Takamoto, MD

Department of Cardiothoracic Surgery Faculty of Medicine University of Tokyo Tokyo, Japan
For reprint information contact: Tomohiro Murakawa, MD Tel: 81 3 5800 8654 Fax: 81 3 5684 3989 email: murakawa-tky{at}umin.ac.jp Department of Cardiothoracic Surgery, Faculty of Medicine, University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo 113-8655, Japan.

   ABSTRACT
TOP
 ABSTRACT
INTRODUCTION
 TECHNIQUE
 DISCUSSION
 REFERENCES
 
Large chest wall defects require surgical reconstruction to ensure structural stability and to prevent flail chest. We used autologous fascia lata grafts to reconstruct skeletal chest wall defects in 8 consecutive patients. Sufficient chest wall stability was obtained; and no complications, such as flail chest, infection, or seroma, have been observed in any of the cases to date.


   INTRODUCTION
TOP
 ABSTRACT
 INTRODUCTION
TECHNIQUE
 DISCUSSION
 REFERENCES
 
Reconstruction after chest wall resection poses a special surgical challenge because of two basic considerations: the anatomical defect and the physiological deficit. If the defect is large and structural stability is required to prevent flail chest, the defect should be reconstructed. Since prosthetic materials are readily available and provide dependable, rigid chest wall reconstruction, their use is preferred in many cases.1,2 The use of fascia lata grafts for skeletal chest wall reconstruction was first described in 1947,3 but today they are used only occasionally. We observed that autologous fascia lata grafts are still used in various reconstructive operations,4,5 so we reappraise their usefulness in skeletal chest wall reconstruction.


   TECHNIQUE
TOP
 ABSTRACT
 INTRODUCTION
 TECHNIQUE
DISCUSSION
 REFERENCES
 
Between 1980 and March 2001, 42 patients underwent skeletal chest wall resection in our department, 16 of whom subsequently underwent chest wall reconstruction for large skeletal wall defects. Since 1996, we began to use nonpedicled fascia lata grafts for reconstruction. We reconstructed skeletal wall defects using autologous fascia lata grafts in 8 consecutive patients (Table 1Go). Their skin and the underlying soft tissues had not been invaded by the tumor. All the patients were male, and the mean age was 60.9 years. Their underlying diseases were primary lung cancer invading the chest wall (5 patients), primary chest wall sarcoma (2 patients), and a metastatic chest wall tumor (1 patient). The largest defect was 19 x 11 cm, requiring the resection of 5 ribs; and the smallest was 7 x 5 cm, requiring the resection of 2 ribs. The mean number of ribs resected was 3, and the mean defect size was 106 cm2.


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  		Table 1. Summary of Patient Data
 
After the chest wall was resected, a nonpedicled fascia lata graft of sufficient size to cover the defect was harvested from the lateral thigh without changing the patient’s position. The graft was attached to the defect site by mattress sutures of 2/0 Ticron (Sherwood Davis & Geck, St. Louis, MO, USA) under tension, and the defect was closed.

Sufficient chest wall stability was obtained by this method. Extubation was performed in the operating theater soon after surgery. Paradoxical movement of the chest wall was not observed. Four patients subsequently underwent adjuvant chemotherapy or radiotherapy. No complications, such as flail chest, infection, or seroma, have been observed in any of the cases to date.


   DISCUSSION
TOP
 ABSTRACT
 INTRODUCTION
 TECHNIQUE
 DISCUSSION
REFERENCES
 
Chest wall reconstruction using a Marlex mesh was first described in 1960.6 Today, various kinds of prosthetic materials are readily available and are preferred in many cases. However, artificial materials can become a focus for infection or cause aseptic inflammation. Infection was reported in 4.6% of patients and seroma in 7.1% in one series of chest wall reconstructions using prosthetic materials.1 Autologous fascia lata grafts have not caused infection or seroma in our patients to date. Moreover, the obvious merit of autologous grafts is cost saving. By using autologous grafts instead of prosthetic materials for chest wall reconstruction, 50,000 ¥ (about US $400) per operation was saved.

The fascia lata graft is easy to harvest and can be obtained in about 15 minutes without changing the patient’s position. The reconstructed chest wall was sufficiently stable in all the cases. No paradoxical movement of the chest wall or complications have been observed in any of the cases so far. The only disadvantage of using this graft is the creation of a second wound. Our conclusion is that fascia lata grafts remain useful and are readily available for chest wall reconstruction.


   REFERENCES
TOP
 ABSTRACT
 INTRODUCTION
 TECHNIQUE
 DISCUSSION
 REFERENCES
 

  1. Deschamps C, Tirnaksiz BM, Darbandi R, Trastek VF, Allen MS, Miller DL, et al. Early and long-term results of prosthetic chest wall reconstruction. J Thorac Cardiovasc Surg 1999;117:588–92.[Abstract/Free Full Text]

  2. Arnold PG, Pairolero PC. Chest-wall reconstruction: an account of 500 consecutive patients. Plast Reconstr Surg 1996;98:804–10.[Medline]

  3. Watson WL, James AG. Fascia lata grafts for chest wall defects. J Thorac Surg 1947;16:399–406.

  4. Kageyama Y, Suzuki K, Matsushita K, Nogimura H, Kazui T. Pericardial closure using fascia lata in patients undergoing pneumonectomy with pericardiectomy. Ann Thorac Surg 1998;66:586–7.[Abstract/Free Full Text]

  5. Savant DN, Patel SG, Bokil KP, Bhathena HM, Kavarana NM, Vyas JJ. Reconstruction of chest wall defects following extirpative surgery. J Surg Oncol 1994;55:186–9.[Medline]

  6. Graham J, Usher FC, Perry JL, Barkley HT. Marlex mesh as a prosthesis in the repair of thoracic wall defects. Ann Surg 1960;151:469–79.





This Article
Right arrow Abstract Freely available
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Right arrow Author home page(s):
Jun Nakajima
Shinichi Takamoto
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Right arrow Articles by Murakawa, T.
Right arrow Articles by Takamoto, S.
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Right arrow Articles by Murakawa, T.
Right arrow Articles by Takamoto, S.
Related Collections
Right arrow Chest wall

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