Research Article| Volume 50, SUPPLEMENT 5, S8-S10, December 2019

The extended latissimus dorsi–serratus anterior chimeric local free flap for salvage of the complicated posterolateral thoractomy incision

Published:October 23, 2019DOI:



      Composite chest wall reconstruction, following the assurance of chest wall stability, often requires well-vascularized soft tissue coverage with flaps to insure adequate wound healing. Unfortunately, prior surgical approaches such as the posterolateral thoractomy incision or extensive wound breakdown may impede the availability of local or regional choices. A free flap would then be a reasonable option, but in the unstable patient a new donor site is unreasonable. Instead, the otherwise inadequate muscle remnants often transected by the usual thoracotomy incision can be extended by microvascular grafts to provide the necessary reach to the defect.


      The ipsilateral cephalic latissimus dorsi and/or serratus anterior muscle remnants following their transection by a posterolateral thoractomy incision can be simultaneously raised as a chimeric flap pedicled in common by the thoracodorsal vessels. The distance the pedicle must be extended to reach the defect requiring coverage is measured, and a vascular graft from the descending branch of the lateral circumflex femoral vessels of the same length is harvested. The thoracodorsal vessels are divided, the vascular graft inserted and anastomosed end-to-end to the cut ends of the former, and then the flap can be stretched the required distance for insetting.


      A case example of use of the ipsilateral latissimus dorsi–serratus anterior muscle remnants used after extension with arterial and venous grafts to the thoracodorsal vessels as the recipient site is presented with successful salvage of a life-threatening posteriolateral thoractomy wound dehiscence.


      Transection of muscles from a posterolateral thoracotomy incision does not preclude their use as flaps in extenuating circumstances. Their pedicle can be extended using vascular grafts and microvascular techniques in a sense to create a local free flap to provide another solution to a challenging problem.


      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'


      Subscribe to Injury
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect


        • Loskena A.
        • Thourani V.H.
        • Carlson G.W.
        • Jones G.E.
        • Culbertson J.H.
        • Miller J.I.
        • Mansour K.A.
        A reconstructive algorithm for plastic surgery following extensive chest wall resection.
        Br J Plast Surg. 2004; 57: 295-302
        • Althubaiti G.
        • Butler C.E.
        Abdominal wall and chest wall reconstruction.
        Plast Reconstr Surg. 2014; 133: 688e-701e
        • Netscher D.T.
        • Baumholtz M.A.
        • Bullocks J.
        Chest reconstruction: II. regional reconstruction of chest wall wounds that do not affect respiratory function (axilla, posterolateral chest, and posterior trunk).
        Plast Reconstr Surg. 2009; 124: 427e-435e
        • Azoury S.C.
        • Grimm J.C.
        • Tuffaha S.H.
        • Broyles J.M.
        • Fischer A.C.
        • Yang S.C.
        • Tufaro A.P.
        Chest wall reconstruction evolution over a decade and experience with a novel technique for complex defects.
        Annal Plast Surg. 2016; 76: 231-237
        • Arnold P.G.
        • Pairolero P.C.
        Chest-wall reconstruction: an account of 500 consecutive patients.
        Plast Reconstr Surg. 1996; 98: 804-810
        • Basta M.N.
        • Fischer J.P.
        • Lotano V.E.
        • Kovach S.J.
        The thoracoplastic approach to chest wall reconstruction: preliminary results of a multidisciplinary approach to minimize morbidity.
        Plast Reconstr Surg. 2014; 134: 959e-967e
        • Hallock G.G.
        Reconstruction of posterior trunk defects.
        Sem Plast Surg. 2011; 25: 78-85
        • Netscher D.T.
        • Baumholtz M.A.
        Chest reconstruction: I. anterior and anterolateral chest wall and wounds affecting respiratory function.
        Plast Reconst Surg. 2009; 124: 240e-252e
        • Persichetti P.
        • Brunetti B.
        • Cagli B.
        • Tenna S.
        Chest wall reconstruction with the perforator-plus thoracoabdominal flap.
        Plast Reconstr Surg. 2012; 130: 488e-489e
        • Zenn M.R.
        • Pribaz J.
        • Walsh M.
        Use of the descending lateral femoral circumflex artery and vein for vascular grafting: a better alternative to an arteriovenous loop.
        Plast Reconstr Surg. 2010; 126: 140-142
        • Moscona R.A.
        • Fodor L.
        • Ben-Nun A.
        • Best L.A.
        Never say no to a damaged muscle the applications of previously damaged pectoralis major and latissimus dorsi muscles for chest wall reconstruction.
        Annal Plast Surg. 2006; 56: 156-159
        • Koch H.
        • Tomaselli F.
        • Pierer G.
        • Schwarzl F.
        • Haas f.
        • Smolle-Jüttner F.M.
        • Scharnagl E.
        Both portions of the latissimus dorsi previously divided in the course of posterolateral thoracotomy.
        Eur J Cardio Thorac Surg. 2002; 21: 874-878
        • Keller A.
        • Allen R.
        • Shaw W.
        The medial gastrocnemius muscle flap: a local free flap.
        Plast Reconstr Surg. 1984; 73: 974-976
        • Salibian A.H.
        • Tesoro V.R.
        • Wood D.L.
        Staged transfer of a free microvascular latissimus dorsi myocutaneous flap using saphenous vein grafts.
        Plast Reconst Surg. 1983; 71: 543-547
        • Hallock G.G.
        Case report: an extended latissimus dorsi “Non-free” flap.
        Br J Plast Surg. 1987; 40: 516-517
        • Nahai F.
        • Hagerty R.
        One-stage microvascular transfer of a latissimus flap to the sacrum using vein grafts.
        Plast Reconstr Surg. 1986; 77: 312-315
        • Hallock G.G.
        The chimera flap: a quarter century odyssey.
        Annal Plast Surg. 2017; 78: 223-229