Abstract
Background
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.
Method
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.
Result
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.
Conclusion
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.
Keywords
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 accessOne-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:
Subscribe to InjuryAlready a print subscriber? Claim online access
Already an online subscriber? Sign in
Register: Create an account
Institutional Access: Sign in to ScienceDirect
References
- A reconstructive algorithm for plastic surgery following extensive chest wall resection.Br J Plast Surg. 2004; 57: 295-302
- Abdominal wall and chest wall reconstruction.Plast Reconstr Surg. 2014; 133: 688e-701e
- 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
- Chest wall reconstruction evolution over a decade and experience with a novel technique for complex defects.Annal Plast Surg. 2016; 76: 231-237
- Chest-wall reconstruction: an account of 500 consecutive patients.Plast Reconstr Surg. 1996; 98: 804-810
- The thoracoplastic approach to chest wall reconstruction: preliminary results of a multidisciplinary approach to minimize morbidity.Plast Reconstr Surg. 2014; 134: 959e-967e
- Reconstruction of posterior trunk defects.Sem Plast Surg. 2011; 25: 78-85
- Chest reconstruction: I. anterior and anterolateral chest wall and wounds affecting respiratory function.Plast Reconst Surg. 2009; 124: 240e-252e
- Chest wall reconstruction with the perforator-plus thoracoabdominal flap.Plast Reconstr Surg. 2012; 130: 488e-489e
- 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
- 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
- Both portions of the latissimus dorsi previously divided in the course of posterolateral thoracotomy.Eur J Cardio Thorac Surg. 2002; 21: 874-878
- The medial gastrocnemius muscle flap: a local free flap.Plast Reconstr Surg. 1984; 73: 974-976
- Staged transfer of a free microvascular latissimus dorsi myocutaneous flap using saphenous vein grafts.Plast Reconst Surg. 1983; 71: 543-547
- Case report: an extended latissimus dorsi “Non-free” flap.Br J Plast Surg. 1987; 40: 516-517
- One-stage microvascular transfer of a latissimus flap to the sacrum using vein grafts.Plast Reconstr Surg. 1986; 77: 312-315
- The chimera flap: a quarter century odyssey.Annal Plast Surg. 2017; 78: 223-229
Article info
Publication history
Published online: October 23, 2019
Footnotes
This paper is part of a Supplement supported by the European Federation of Societies of Microsurgery (EFSM) and the Serbian Society for Reconstructive Microsurgery (SSRM).
Identification
Copyright
© 2019 Published by Elsevier Ltd.
