Extended cutaneous 'thoracoabdominal' flap for large chest wall reconstruction

Major chest wall reconstructions are usually required after radical excision of advanced cancer stages and large radionecrosis in patients with poor general conditions. Faciocutaneous, muscular, and musculocutaneous flaps have all been described, with the last ones being commonly considered a first choice. The authors introduce an extended pure cutaneous flap from the omolateral thoracoabdominal area that is able to cover extensive defects. The vascular supply is provided by the lateral cutaneous branches from intercostal, subcostal, and lumbar arteries. Between February 2002 and 2005, 18 female patients underwent major chest wall reconstruction with this technique. Flap dimensions ranged between 15 x 15 and 25 x 30 cm. No major complications were registered. Four flaps sustained a partial loss at the distal margin but 1 case only required further surgical debridement. The extended cutaneous "thoracoabdominal" flap proved to be a quick, single-stage procedure with a low morbidity rate, specifically indicated in patients with a poor prognosis.