Complex thoracic wounds: muscle and musculocutaneous anatomy in closure

Closure of the infected sternotomy has been facilitated by the use of the pectoralis major musculocutaneous flap and has been well described. This paper describes six cases of more complex infected thoracotomies and the methods of closure. Knowledge of the dual blood supply of many of the thoracic musculocutaneous units is important in closure of these difficult thoracic wounds. The axial and segmental blood supply of the large flat muscles of the chest wall can be exploited to satisfy complex defects involving both vertical and transverse thoracotomy incisions and therefore decrease the risk of progressive infection and erosion of major vascular structures.