Chest Repair Following Mammary Lymphadenectomy

Arch Surg. 1961;83(2):231-236. doi:10.1001/archsurg.1961.01300140073013.
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Thoracic wall defects secondary to surgery for tumors in this area frequently are sufficiently small so that they require no specific attention. Even when their size might lead to detrimental paradoxical respiration, covering them with the overlying muscle layers minimizes such motion. When overlying muscle layers are not present, adjacent muscle bundles such as the pectoralis major or latissimus dorsi can be mobilized as pedicle flaps with their intact neurovascular supply in order to cover the defect. Whenever possible, we utilize overlying or adjacent muscle tissue to effect such repair.

However, thoracic wall defects secondary to internal mammary lymphadenectomy done in continuity with a radical mastectomy pose unique problems in their repair. The defect extends from the lateral one centimeter of sternum to the costochondral junction, and from the first to the fifth interspace (Fig. 1,A). As can be seen from the accompanying diagram (Fig. 1,B), in a


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