Diaphragm mobilization for closure of chest wall defects

Locally disseminated breast carcinoma after a simple or radical mastectomy and radiotherapy causes serious surgical problems. Excision of the chest wall obliterates the negative intrapleural pressure, and wound healing within a previously irradiated area is notoriously poor. A new method is described in which the diaphragm is mobilized and reinserted into the defect to allow final resurfacing with a skin graft or locally rotated skin flap. This simple surgical method is advocated when the prognosis is poor and breast reconstruction is not being considered.