• Stijn Vanstraelen, Barkat Ali, Manjit S Bains, Farooq Shahzad, Robert J Allen, Evan Matros, Joe Dycoco, Prasad S Adusumilli, Matthew J Bott, Robert J Downey, James Huang, James M Isbell, Daniela Molena, Bernard J Park, Valerie W Rusch, Smita Sihag, Peter G Cordeiro, Michelle R Coriddi, Joseph H Dayan, Joseph Disa, Colleen M McCarthy, Jonas A Nelson, Carrie Stern, Babak Mehrara, David R Jones, and Gaetano Rocco.
• Thoracic Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY.
• J. Thorac. Cardiovasc. Surg. 2023 Oct 1; 166 (4): 12621272.e21262-1272.e2.

ObjectivePedicled flaps (PFs) have historically served as the preferred option for reconstruction of large chest wall defects. More recently, the indications for microvascular-free flaps (MVFFs) have increased, particularly for defects in which PFs are inadequate or unavailable. We sought to compare oncologic and surgical outcomes between MVFFs and PFs in reconstructions of full-thickness chest wall defects.MethodsWe retrospectively identified all patients who underwent chest wall resection at our institution from 2000 to 2022. Patients were stratified by flap reconstruction. End points were defect size, rate of complete resection, rate of local recurrence, and postoperative outcomes. Multivariable analysis was performed to identify factors associated with complications at 30 days.ResultsIn total, 536 patients underwent chest wall resection, of whom 133 had flap reconstruction (MVFF, n = 28; PF, n = 105). The median (interquartile range) covered defect size was 172 cm2 (100-216 cm2) for patients receiving MVFF versus 109 cm2 (75-148 cm2) for patients receiving PF (P = .004). The rate of R0 resection was high in both groups (MVFF, 93% [n = 26]; PF, 86% [n = 90]; P = .5). The rate of local recurrence was 4% in MVFF patients (n = 1) versus 12% in PF patients (n = 13, P = .3). Postoperative complications were not statistically different between groups (odds ratio for PF, 1.37; 95% confidence interval, 0.39-5.14]; P = .6). Operative time >400 minutes was associated with 30-day complications (odds ratio, 3.22; 95% confidence interval, 1.10-9.93; P = .033).ConclusionsPatients with MVFFs had larger defects, a high rate of complete resection, and a low rate of local recurrence. MVFFs are a valid option for chest wall reconstructions.Copyright © 2023 The American Association for Thoracic Surgery. Published by Elsevier Inc. All rights reserved.

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