Pedicled Trapezius Flap With NPWT for a Chest Wall Defect

Abstract and Introduction

Abstract

Background: Traumatic chest wall defect normally involves severe tissue damage and easily develops into intrathoracic infection. The challenge for doctors is to control the infection and reconstruct the chest wall defect. However, not much experience has been reported on how to control the intrathoracic infection and reconstruct the chest wall defect when the most commonly used muscle flaps are damaged.

Methods: We present a case of a 46-year-old male patient who sustained a traumatic amputation of the right upper extremity in a forklift accident. The scapula and clavicle were partially amputated. The right lung was exposed to the outside and finally developed into intrathoracic infection. The intrathoracic infection was successfully controlled by applying negative pressure wound therapy, followed with reconstruction using a pedicled trapezius flap.

Results: The patient resumed normal life after the surgery. No complications had developed at the 2-year follow-up. The respiratory function of the patient was barely affected, but the trapezius flap moved when the patient breathed.

Conclusions: This case report demonstrates the effectiveness of negative pressure wound therapy in controlling intrathoracic infection after a traumatic chest wall defect as well as the possibility of applying trapezius muscle flap to reconstruct the chest defect when the commonly used muscle flaps are not available.

Introduction

Traumatic chest wall defect normally involves severe tissue damage.^[1] Most patients die before rescue because the progress of the disease is dramatically rapid. Those patients who manage to arrive to the emergency department still face a high mortality due to difficulties in treating the disease and its complications.^[2] Therefore, few cases of reconstruction of traumatic chest wall defect have been reported. Both soft tissues and bony structures may need to be reconstructed for a chest wall defect.^[3] However, whether or not to restore the skeletal stability of the chest wall is still being debated.^[3] When the size of the soft tissue defect is larger than 5 cm, locoregional muscle flaps are commonly needed to cover the defect. The most frequently used muscle flaps are pectoralis major, latissimus dorsi, serratus anterior, and rectus abdominis.^[4] However, if these muscles cannot be used in patients with a massive chest wall defect, no consensus has been reached on which flap to use as an alternative. Free flap is one of the options.^[4] The advantages of free flaps are the relatively controllable size of the donor site and that they have no effect on respiratory function. However, it has a higher failure risk compared with the locoregional muscle flaps due to a high requirement for the condition of recipient vessels and soft tissues. Complete debridement and infection control are the basis for a successful reconstruction of the chest wall.^[5] Traditionally, intrathoracic infection is treated with closed thoracic drainage and antibiotics. As a new treatment method, negative pressure wound therapy has a remarkable effect on controlling infection and promoting would healing,^[6,7] but only a few studies reported its application for intrathoracic infection.^[8] This report describes a case in which a massive traumatic chest wall defect with intrathoracic infection was successfully reconstructed by combining pedicled trapezius flap and negative pressure wound therapy.