Complex Thoracoabdominal Reconstruction After a Thoracic Oncological Resection

Aim Surgical reconstruction of the thoracoabdominal region after resective oncological procedures is a surgical challenge. We present our approach to this situation. Material and Methods 67-year-old patient with the diagnosis of a mixoid sarcoma in the lower left thoracic wall. Previous myocardial stroke (double by-pass), chronic obstructive pulmonary disease, arterial hypertension and obesity (BMI 32.6). An oncological resection including the left 8th, 9th, and 10th left ribs, diaphragm, and the lateral musculature of the abdominal wall is performed. A diaphragmatic PTFE bridged mesh augmentation is performed to maintain pulmonary capacity. The reconstruction is based in the overextended dissection of the preperitoneal retromuscular space and the subdiaphragmatic area, restoring the muscular continuity after reinforcing the dissected area with a reinforced 25 × 30 biological mesh and a 35 × 40 cm large pore polypropylene mesh. The resected area is covered with muscular flaps of the transversus abdominis, anterior serratus and latissimus dorsi muscles with full coverage of the meshes. Results No immediate postoperative complications. Discharged in the sixth postoperative day without any complications. No abdominal wall instability after 18-month follow-up. Oncological progression with lung metastasis. Conclusion Anatomical restauration of the thoracoabdominal junction after oncological resections is based in the overextended preperitoneal retromuscular dissection with the use of large pieces of meshes, covered with flaps of the surrounding muscles.