Chest Wall Defect With an Extensively Encroached Heart and Severely Impaired Cardiac Function
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Prior to flap transfer, an occlusion test of the deep inferior epigastric vessels was further performed to confirm the patency of the superior epigastric vessels. Nevertheless, angiography of vessels should be recommended for the safe preoperative evaluation of the vertical RAM inflow vessels.
It is also important to note that such a reconstruction should only be undertaken with a cardiac surgeon present. The close cooperation between a reconstructive and cardiothoracic surgeon in this case made it possible to limit the occurrence of the vital implications and repair the unexpected myocardial tears.
A complex chest wall defect with the heart extensively encroached due to radiation injury was treated with minimal debridement followed by vertical RAM island flap, which allowed for an early reconstruction and facilitated successful reversal of cardiac dysfunction, thus avoiding a life-threatening situation. This successful experience should prove helpful for the reconstructive surgeon in management of similar cases.
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