Free flap chest wall reconstruction for recurrent breast cancer and radiation ulcers

Pedicled myocutaneous flaps are the established first choice for soft tissue coverage of major chest wall defects. In some patients, this alternative is not available because the flap itself or its blood supply may be included within the field of surgical resection, the flap may have been used previously, or the defect is too large or extends past the reach of the flap. In these patients, free flaps can be used to provide adequate soft tissue coverage. This report examines 7 women with major full-thickness chest wall defects treated with free flap soft tissue coverage. Either a rectus abdominis (6 women) or a latissimus dorsi myocutaneous free flap (1 woman) was used. There were no flap failures. Permanent protection of prosthetic material used to stabilize the chest wall was provided in all women. Only 1 woman experienced delayed wound healing. Secondary procedures were not required in any patient. Myocutaneous free flaps provide reliable single-stage soft tissue coverage for large chest wall defects that are not suited to reconstruction with pedicled myocutaneous flaps.