Reconstruction of oncologic torso defects: emphasis on microvascular reconstruction

A large variety of pedicle flaps centered at the shoulder girdle or pelvic girdle, or derived from the epigastric axis, are generally available to reconstruct defects of the torso. However, microvascular free flap reconstruction may occasionally be required for: 1) locations that are difficult to reach with pedicle flaps (the posterolateral iliac crest region, epigastrium, lower lumbar and sacral, and upper back and lower central); 2) locations in which muscles or their vascular pedicles have been destroyed by surgical ablation or irradiation; 3) a large-volume "dead space" or a large surface area that may be inadequately covered by available regional flaps; and 4) a combination of factors. Whether using a pedicle or free flaps, the reconstructive requirements of torso reconstruction must be met: 1) to restore chest wall or abdominal wall integrity, 2) to fill "dead space," 3) to cover vital exposed structures, 4) to maintain skeletal stability of the thoracic cage and minimize respiratory compromise, and 5) to buttress visceral repairs. Semin. Surg. Oncol. 19:255-263, 2000.