Combined Free Vascularized Iliac Osteocutaneous Flap and Pedicled Pectoralis Major Myocutaneous Flap for Reconstruction of Anterior Chest Wall Full-Thickness Defect

Large defects of the anterior chest wall lead to gross chest instability that can result in paradoxic respiration. Osteoradionecrosis of the lower sternum and multiple left ribs resulted in a huge, full-thickness defect of the left anterior chest wall in a 67-year-old woman. An iliac osteocutaneous flap (bone segment 3 x 14 cm) was harvested for reconstruction of the bone defect. The skin defect was covered by the skin paddle of the iliac osteocutaneous flap and a contralateral rotational pectoralis major muscle flap. Months postoperatively, the patient was physically active, the chest was stable, and the vascularized iliac bone was incorporated into the recipient bone. (Ann Thorac Surg 2011;91:586-8) (C) 2011 by The Society of Thoracic Surgeons