Background: Reconstruction of chest wall defects after oncologic resection requires techniques that minimize wound morbidity and preserve timely access to adjuvant therapy. The Kiss Latissimus Dorsi (LD) flap offers robust, well-vascularized tissue with reliable healing, while extended thoracoabdominal hatchet flaps provide a muscle-sparing alternative based on local perforators. Comparative data between these approaches remain limited. Methods: A retrospective cohort study was conducted including female patients who underwent chest wall reconstruction between 2015 and 2023 using either a Kiss LD flap (n = 11) or an extended thoracoabdominal hatchet flap (n = 12). Groups were comparable in demographic and clinical characteristics. The primary endpoint was time to complete wound healing. Secondary endpoints included wound complications, delayed healing (> 30 days), need for reintervention, and timing of adjuvant therapy. Results: Healing occurred significantly earlier in the Kiss LD group compared with the hatchet group (21.7 ± 5.2 vs. 34.5 ± 8.7 days; p < 0.001). Delayed healing was less frequent in the Kiss LD flap group (9.1% vs. 50.0%; p = 0.02). Overall wound complications were lower in the Kiss LD cohort (18.2% vs. 41.7%; p = 0.048), and no reinterventions were required, whereas one patient in the hatchet group required debridement. Patients in the Kiss LD group initiated adjuvant therapy earlier than those in the hatchet group (33.4 ± 6.5 vs. 47.8 ± 9.9 days; p < 0.001). Conclusions: The Kiss Latissimus Dorsi flap was associated with faster and more reliable healing than the extended thoracoabdominal hatchet flap, alongside earlier initiation of adjuvant therapy. The Kiss LD flap may represent a reliable reconstructive strategy for oncologic patients when treatment sequencing is essential.
Comparative Outcomes of Kiss Latissimus Dorsi Flap Versus Extended Thoracoabdominal Hatchet Flap for Large Chest Wall Reconstruction: A Retrospective Cohort Study
Lombardo, Giuseppe Angelo Giovanni;Malara, Giovanna;Catalano, Francesca
2026-01-01
Abstract
Background: Reconstruction of chest wall defects after oncologic resection requires techniques that minimize wound morbidity and preserve timely access to adjuvant therapy. The Kiss Latissimus Dorsi (LD) flap offers robust, well-vascularized tissue with reliable healing, while extended thoracoabdominal hatchet flaps provide a muscle-sparing alternative based on local perforators. Comparative data between these approaches remain limited. Methods: A retrospective cohort study was conducted including female patients who underwent chest wall reconstruction between 2015 and 2023 using either a Kiss LD flap (n = 11) or an extended thoracoabdominal hatchet flap (n = 12). Groups were comparable in demographic and clinical characteristics. The primary endpoint was time to complete wound healing. Secondary endpoints included wound complications, delayed healing (> 30 days), need for reintervention, and timing of adjuvant therapy. Results: Healing occurred significantly earlier in the Kiss LD group compared with the hatchet group (21.7 ± 5.2 vs. 34.5 ± 8.7 days; p < 0.001). Delayed healing was less frequent in the Kiss LD flap group (9.1% vs. 50.0%; p = 0.02). Overall wound complications were lower in the Kiss LD cohort (18.2% vs. 41.7%; p = 0.048), and no reinterventions were required, whereas one patient in the hatchet group required debridement. Patients in the Kiss LD group initiated adjuvant therapy earlier than those in the hatchet group (33.4 ± 6.5 vs. 47.8 ± 9.9 days; p < 0.001). Conclusions: The Kiss Latissimus Dorsi flap was associated with faster and more reliable healing than the extended thoracoabdominal hatchet flap, alongside earlier initiation of adjuvant therapy. The Kiss LD flap may represent a reliable reconstructive strategy for oncologic patients when treatment sequencing is essential.I documenti in IRIS sono protetti da copyright e tutti i diritti sono riservati, salvo diversa indicazione.
