Chest wall reconstruction using an omental flap and Integra

We present the case of a 58-year-old lady who developed radionecrosis following irradiation of the chest wall following mastectomy. The ensuing radionecrosis of the soft tissue and bony rib cage on the left side of the chest wall progressed to advanced ischaemia with secondary infection and abscess formation. Initially the patient underwent left-sided chest wall reconstruction using a right-sided pedicled TRAM flap. The flap eventually became ischaemic and necrosed over a period of 3 weeks leaving the pleura and ribs exposed. The patient underwent VAC Therapy in order to promote the formation of granulation tissue. Several weeks later the greater Omentum was harvested as a pedicled flap and transposed into the defect which was then in turn covered with Integra and a split-skin graft. Complete wound closure was obtained with this Integra-omental flap reconstructive technique.