Chest Wall Reconstruction in Male Poland Syndrome Patients with Endoscopic-Assisted Latissimus Dorsi Muscle Flap Transfer

Abstract

Background: Pectoralis major absence generates chest wall deformity and always requires surgical intervention. This study aimed to introduce a technique to reconstruct the chest wall for male Poland Syndrome patients with endoscopic latissimus dorsi muscle (ELDM) flap via a single transverse axillary incision and evaluate its safety and effectiveness.

Methods: A prospective study was designed to recruit male Poland Syndrome candidates for ELDM chest reconstruction. By performing a short and hidden transaxillary incision, we created anterior chest wall pocket and transferred the latissimus dorsi muscle (LDM) flap to recontour the chest wall. Data for patient demographics, LDM flap dimension, operative time, and complications were collected. Upper extremity functional disabilities were evaluated by the disabilities of the arm, shoulder and hand (DASH) outcome questionnaire. Satisfaction with the outcome was measured by satisfaction with outcome subscale of the BREAST-Q questionnaire.

Results: This study recruited 11 eligible patients to receive ELDM chest wall reconstruction. ELDM flap harvesting averagely consumed 79.9 minutes. Without significant complications, all patients recovered uneventfully. Chest wall anomalies of different severity were corrected safely and effectively. The score of DASH was 3.7±3.3 preoperatively and 4.0±3.7 postoperatively with no statistically significant difference. The score of satisfaction with the outcome was 84.8±14.3.

Conclusions: For chest wall anomalies of different severity in male Poland Syndrome patients, the ELDM technique provides a safe and efficient way to reconstruct the chest wall with a better aesthetic outcome, high satisfaction rate, and satisfactory upper limb function.

Keywords: Chest reconstruction; Endoscope; Latissimus dorsi muscle flap; Poland Syndrome.