Modified External Oblique Myocutaneous Flap for Repair of Postmastectomy Defects in Locally Advanced Breast Tumors: A Cohort Series Associated with a Systematic Review of Literature

Abstract

Background

Locally advanced breast tumors (LABT) are situations of difficult resolution in clinical practice. External oblique myocutaneous flap (EOMF) is an option, but there are few studies in the literature on its use.

Methods

This was a retrospective, cohort institutional study of patients with LABT who were undergoing mastectomy combined with the use of modified-EOMF (M-EOMF). Preoperative indications and conditions, factors associated with surgery, time to radiotherapy, local recurrence, and survival were assessed. A systematic review of the literature also was performed to evaluate the use of EOMF.

Results

Over the 10-year period, 17 patients underwent M-EOMF closure. The mean duration of surgery was 251 min, and extensive skin area was resected (mean 468 ± 260 cm2). Four patients developed local recurrence. The actuarial survival at 36 months was 48.3%. Using PRISMA statement, among 115 articles evaluated from 3 databases, 8 articles were selected, in which 146 patients underwent EOMF. EOMF are associated with low postoperative complications with 8.9% skin necrosis. The M-EOMF allowed the resection of larger areas than other flaps described in the literature but is associated with skin necrosis.

Conclusions

M-EOMF has the advantages of not requiring a change in the patient’s position for the closure of large areas. It is thus an acceptable option for chest wall reconstruction in tumors at the limit of resectability.

This is a preview of subscription content, log in to check access.

Fig. 1
Fig. 2
Fig. 3
Fig. 4

References

  1. 1.

    Torre LA, Bray F, Siegel RL, Ferlay J, Lortet-Tieulent J, Jemal A. Global cancer statistics, 2012. CA Cancer J Clin. 2015;65(2):87–108.

    PubMed  Article  Google Scholar 

  2. 2.

    Vieira RA, Uemura G, Zucca-Matthes G, Costa AM, Micheli RA, Oliveira CZ. Evaluating breast cancer health system between countries: the use of USA/SEER and Brazilian women as a cohort sample. Breast J. 2015;21(3):322–3.

    PubMed  Article  Google Scholar 

  3. 3.

    Munhoz AM, Montag E, Arruda E, et al. Immediate locally advanced breast cancer and chest wall reconstruction: surgical planning and reconstruction strategies with extended V–Y latissimus dorsi myocutaneous flap. Plast Reconstr Surg. 2011;127(6):2186–97.

    CAS  PubMed  Article  Google Scholar 

  4. 4.

    Micali E, Carramaschi FR. Extended V–Y latissimus dorsi musculocutaneous flap for anterior chest wall reconstruction. Plast Reconstr Surg. 2001;107(6):1382–90. (discussion 1391–2).

    CAS  PubMed  Article  Google Scholar 

  5. 5.

    Baroudi R, Pinotti JA, Keppke EM. A transverse thoracoabdominal skin flap for closure after radical mastectomy. Plast Reconstr Surg. 1978;61(4):547–54.

    CAS  PubMed  Article  Google Scholar 

  6. 6.

    Charanek AM. A bilobed thoracoabdominal myocutaneous flap for large thoracic defects. Ann Plast Surg. 2014;72(4):451–6.

    CAS  PubMed  Article  Google Scholar 

  7. 7.

    Deo SV, Purkayastha J, Shukla NK, Asthana S. Myocutaneous versus thoraco-abdominal flap cover for soft tissue defects following surgery for locally advanced and recurrent breast cancer. J Surg Oncol. 2003;83(1):31–5.

    PubMed  Article  Google Scholar 

  8. 8.

    Fui AC, Hong GS, Ng EH, Soo KC. Primary reconstruction after extensive chest wall resection. Aust N Z J Surg. 1998;68(9):655–9.

    CAS  PubMed  Article  Google Scholar 

  9. 9.

    Pantelides NM, Mondal D, Wishart GC, Malata CM. Reverse abdominoplasty: a practical option for oncological trunk reconstruction. Eplasty. 2013;13:e2.

    PubMed  PubMed Central  Google Scholar 

  10. 10.

    Daigeler A, Simidjiiska-Belyaeva M, Drucke D, et al. The versatility of the pedicled vertical rectus abdominis myocutaneous flap in oncologic patients. Langenbeck’s Arch Surg Deutsche Gesellschaft fur Chirurgie. 2011;396(8):1271–9.

    Article  Google Scholar 

  11. 11.

    Rivas B, Carrillo JF, Escobar G. Reconstructive management of advanced breast cancer. Ann Plast Surg. 2001;47(3):234–9.

    CAS  PubMed  Article  Google Scholar 

  12. 12.

    Hanagiri T, Nozoe T, Yoshimatsu T, et al. Surgical treatment for chest wall invasion due to the local recurrence of breast cancer. Breast Cancer. 2008;15(4):298–302.

    PubMed  Article  Google Scholar 

  13. 13.

    Martella S, Caliskan M, Brenelli FP, et al. Surgical closure of chest wall in noninflammatory locally advanced breast carcinoma with ulceration of the skin. Breast J. 2008;14(4):345–52.

    PubMed  Article  Google Scholar 

  14. 14.

    Park JS, Ahn SH, Son BH, Kim EK. Using local flaps in a chest wall reconstruction after mastectomy for locally advanced breast cancer. Arch Plast Surg. 2015;42(3):288–94.

    PubMed  PubMed Central  Article  Google Scholar 

  15. 15.

    Parkash S, Srinivasan R, Ananthakrishnan N. Primary closure of excisional defects of the breast with local flaps: a problem in the treatment of advanced carcinoma of the breast in developing countries. Br J Plast Surg. 1981;34(3):291–4.

    CAS  PubMed  Article  Google Scholar 

  16. 16.

    Tukiainen E. Chest wall reconstruction after oncological resections. Scand J Surg. 2013;102(1):9–13.

    CAS  PubMed  Article  Google Scholar 

  17. 17.

    Vieira R, da Silva KMT, de Oliveira-Junior I, de Lima MA. ITADE flap after mastectomy for locally advanced breast cancer: a good choice for mid-sized defects of the chest wall, based on a systematic review of thoracoabdominal flaps. J Surg Oncol. 2017;115(8):949–58.

    PubMed  Article  Google Scholar 

  18. 18.

    Vieira RAC, Boni R, Silva VD. Reply: ITADE flap after mastectomy for locally advanced breast cancer: a good choice for mid-sized defects of the chest wall based on a systematic review of thoracoabdominal flaps. J Surg Oncol. 2019;119(8):1182–3.

    CAS  PubMed  Article  Google Scholar 

  19. 19.

    Salo JTK, Tukiainen EJ. Oncologic resection and reconstruction of the chest wall: a 19-year experience in a single center. Plast Reconstr Surg. 2018;142(2):536–47.

    CAS  PubMed  Article  Google Scholar 

  20. 20.

    Harati K, Kolbenschlag J, Behr B, et al. Thoracic wall reconstruction after tumor resection. Front Oncol. 2015;5:247.

    PubMed  PubMed Central  Article  Google Scholar 

  21. 21.

    Tiong WH, Basiron NH. Reverse abdominoplasty flap in reconstruction of post-bilateral mastectomies anterior chest wall defect. Case Rep Med. 2014;2014:942078.

    PubMed  PubMed Central  Article  Google Scholar 

  22. 22.

    Zhang R, Wang C, Chen Y, Zheng B, Shi Y. The use of unilateral or bilateral external oblique myocutaneous flap in the reconstruction of lower abdominal wall or groin defects after malignant tumor resection. J Surg Oncol. 2014;110(8):930–4.

    PubMed  Article  Google Scholar 

  23. 23.

    Woo E, Tan BK, Koong HN, Yeo A, Chan MY, Song C. Use of the extended V-Y latissimus dorsi myocutaneous flap for chest wall reconstruction in locally advanced breast cancer. Ann Thorac Surg. 2006;82(2):752–5.

    PubMed  Article  Google Scholar 

  24. 24.

    Bogossian N, Chaglassian T, Rosenberg PH, Moore MP. External oblique myocutaneous flap coverage of large chest-wall defects following resection of breast tumors. Plast Reconstr Surg. 1996;97(1):97–103.

    CAS  PubMed  Article  Google Scholar 

  25. 25.

    Kuge H, Kuzumoto Y, Morita T. Reconstruction of an extensive chest wall defect using an external oblique myocutaneous flap following resection of an advanced breast carcinoma: report of a case. Breast Cancer. 2006;13(4):364–8.

    PubMed  Article  Google Scholar 

  26. 26.

    Moschella F, Cordova A. A new extended external oblique musculocutaneous flap for reconstruction of large chest-wall defects. Plast Reconstr Surg. 1999;103(5):1378–85.

    CAS  PubMed  Article  Google Scholar 

  27. 27.

    Abdel-Fattah M, Abdel-Fattah A, Salem IL, El-Barany W. The modified external oblique musculocutaneosu flap for reconstruction of extensive post-mastectomy radio necrosis: clinical and anatomical study. Egypt J Plast Reconstr. Surg. 2004;28(1):1–5.

    Google Scholar 

  28. 28.

    Lee S, Jung Y, Bae Y. Immediate chest wall reconstruction using an external oblique myocutaneous flap for large skin defects after mastectomy in advanced or recurrent breast cancer patients: a single-center experience. J Surg Oncol. 2018;117(2):124–9.

    PubMed  Article  Google Scholar 

  29. 29.

    Moher D, Liberati A, Tetzlaff J, Altman DG, Group P. Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement. J Clin Epidemiol. 2009;62(10):1006–12.

    Article  Google Scholar 

  30. 30.

    Cordova A, Stagno D’Alcontres F, Corradino B, Napoli P, Latteri F, Moschella F. [External oblique muscle-cutaneous flap use of the in the reconstruction of large chest wall defects after mastectomy]. Minerva Chir. 2002;57(2):229–36.

    CAS  PubMed  Google Scholar 

  31. 31.

    Gesson-Paute A, Ferron G, Garrido I. External oblique musculocutaneous flap for chest wall reconstruction. Plast Reconstr Surg. 2008;122(5):159e–60e.

    PubMed  Article  Google Scholar 

  32. 32.

    Matera D, Huynh R, Hanley T, Behnam AB. Revisiting the musculocutaneous external oblique flap as a versatile alternative in large thoracic wall defects. Surg Case Rep. 2019;5(1):148.

    PubMed  PubMed Central  Article  Google Scholar 

  33. 33.

    Hershey FB, Butcher HR, Jr. Repair of defects after partial resection of the abdominal wall. Am J Surg. 1964;107:586–90.

    CAS  PubMed  Article  Google Scholar 

  34. 34.

    Hodgkinson DJ, Arnold PG. Chest-wall reconstruction using the external oblique muscle. Br J Plast Surg. 1980;33(2):216–20.

    CAS  PubMed  Article  Google Scholar 

  35. 35.

    Wang CM, Zhang R, Luo P, et al. Reconstruction of extensive thoracic wall defect using the external oblique myocutaneous flap: an analysis on 20 Chinese patients with locally advanced soft tissue sarcoma. J Surg Oncol. 2018;117(2):130–6.

    PubMed  Article  Google Scholar 

  36. 36.

    Matros E, Disa JJ. Uncommon flaps for chest wall reconstruction. Sem Plast Surg. 2011;25(1):55–9.

    Article  Google Scholar 

Download references

Acknowledgments

The authors thank our colleagues Rodrigo Augusto Depieri Michelli and Antônio Bailão Junior, who contributed cases to the present study.

Funding

No funding was acquired.

Author information

Affiliations

Authors

Contributions

Vieira RAC performed the conception, design, analysis, and interpretation of the data. Oliveira-Junior and Branquinho LI performed design, acquisition of the data. Ching AW and Haikel RL performed the conception and interpretation of the data. All authors performed substantial contribution, assuming the integrity of this article, reading and approving the final version.

Corresponding author

Correspondence to René Aloisio da Costa Vieira MD, PhD.

Ethics declarations

Disclosures

The authors declare disclosure of interest.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Electronic Supplementary Material

Below is the link to the electronic supplementary material.

Supplementary material 1 (DOCX 93 kb)

Rights and permissions

Reprints and Permissions

About this article

Verify currency and authenticity via CrossMark

Cite this article

da Costa Vieira, R.A., de Oliveira-Junior, I., Branquinho, L.I. et al. Modified External Oblique Myocutaneous Flap for Repair of Postmastectomy Defects in Locally Advanced Breast Tumors: A Cohort Series Associated with a Systematic Review of Literature. Ann Surg Oncol (2020). https://doi.org/10.1245/s10434-020-09205-y

Download citation