Chest wall reconstruction--management of the difficult chest wound

Full-thickness chest wall defects after ablative surgery for metastatic cancer, trauma, infection, or irradiation injury have posed major and often impossible dilemmas for reconstruction. At times, resection has had to be abandoned because reconstruction was deemed infeasible. However, recent knowledge of the multicentric blood supply and anatomy of the latissimus dorsi and pectoralis major muscle make it possible to use these muscles and myocutaneous units (even following division of their major blood supply) for reconstruction of the chest wall. The reconstruction of difficult anterolateral chest wall defects is discussed and the options available to the surgeon before and after interruption of the major blood supply to these flaps are presented.