Combined reconstruction of complex chest wall defects using mesh-supported rigid materials and abdominal flap strategies: a retrospective clinical study

Abstract

Background – Management of recurrent or primary chest wall tumors and radiation-induced ulcers poses significant challenges due to extensive full-thickness defects following radical resection. Simultaneous reconstruction of the thoracic skeleton and soft tissue is imperative for preserving chest wall functionality. This study addresses this clinical dilemma through optimized surgical strategies. Methods – A retrospective cohort analysis (2016-2023) included 42 consecutive patients with Mathes-Salibian grade III/IV defects at Hunan Cancer Hospital. Outcomes were assessed for bony reconstruction (titanium alloy/polypropylene mesh vs. bone cement/mesh) and soft-tissue coverage (free/pedicled flap combinations). Results – Among 42 patients (41 female, 1 male), 38 presented with full-thickness defects. Bony reconstruction utilized titanium alloy/nylon mesh (n = 7) or bone cement/nylon mesh (n = 27). All cases required flaps, with 28 patients receiving combined free deep inferior epigastric perforator (DIEP) flaps and contralateral pedicled transverse rectus abdominis myocutaneous (TRAM) flaps. Postoperatively, one mortality occurred due to multi-organ failure; local complications were managed conservatively. During mean follow-up (30.29 months), 2 patients succumbed to metastatic breast cancer and 1 to cardiovascular events. Remaining patients showed no ulcer recurrence or local tumor progression. Conclusion – Mesh-reinforced rigid reconstruction provides stable thoracic restoration. The integrated DIEP-TRAM flap approach delivers extensive vascularized coverage with 97.7% successful defect resolution, establishing an effective protocol for complex chest wall rehabilitation.