Operations for Sarcomas on the Chest and Abdominal Walls

Abstract

Soft-tissue sarcomas arising in the chest wall are unusual tumors which are difficult to manage owing to the limited thickness of the soft tissues overlying the ribs, rib cartilages, intercostal muscles, and sternum. Obtaining an adequate margin on these tissues often requires resection of the full thickness of the chest wall, and traditional repairs have included the use of fascia or prosthetic mesh to prevent functional disabilities (flail chest) (1–3,5–10). When a limited skin and chest wall resection has been performed, local skin flaps can be mobilized to obtain coverage over the chest wall closure. Recently, the use of myocutaneous flaps has provided more reliable replacement of extensive full-thickness chest wall defects (7). Flaps that can be used include the latissimus dorsi, pectoralis major, or rectus abdominis myocutaneous flaps (see Chapter 9). These flaps have the advantage of the use of autogenous, vascularized fascia to obtain a good chest wall closure, thus preventing paradoxical motion and potential late breakdown of the chest wall closure. In addition, adequate skin coverage is obtained. The resulting skin defect may be closed primarily or with a split-thickness skin graft. Another method of chest wall reconstruction includes the use of omentum (4). This can be rotated through the abdomen, thus not requiring a microvascular anastomosis, and can be placed on top of either fascia lata or synthetic mesh and covered with a split-thickness skin graft. These methods all enable the surgeon to perform a wide soft-part resection, thus decreasing the chance of local recurrence developing in these patients.