Chest reconstruction: II. Regional reconstruction of chest wall wounds that do not affect respiratory function (axilla, posterolateral chest, and posterior trunk).

LEARNING OBJECTIVES

The reader of this review will develop knowledge and understanding of the following: 1. Indications for posterior trunk and axillary reconstruction. 2. The reconstructive requirements of posterior chest wall and axillary wounds. 3. Flaps for regional reconstruction of the torso and axilla. 4. Congenital posterior trunk deformities and their management. 5. The role of microvascular surgery in chest wall reconstruction. 6. The recent emphasis on the role of perforator flaps. 7. The relative advantages and disadvantages of muscle flaps versus perforator skin and fasciocutaneous flaps.

BACKGROUND

Regional reconstructions of the axilla, posterolateral chest, and posterior trunk may prove difficult because of relative inaccessibility for pedicle flaps, exposure of prosthetic material, and loss of function.

METHODS

Review of past and current medical literature, together with personal experience, has enabled development of this article.

RESULTS

A host of regional muscle and musculocutaneous pedicle flaps are available from both the upper and lower limb girdle. These muscle flaps, however, come at the price of compromising donor motor function. This donor morbidity can be reduced either by segmentally splitting muscle flaps or by recourse to perforator artery flaps. Some areas may be difficult to reach, especially the upper and lower back in the midline. Occasionally, microvascular reconstruction is required. Tissue expansion has a limited role in these reconstructions but most notably is an aid to separation of conjoined twins.

CONCLUSIONS

A variety of regional fasciocutaneous and musculocutaneous flaps are available to cover congenital or acquired defects of the posterior trunk and axilla. Use of perforator flaps has recently been popularized. One must be cognizant of possible functional deficits that may result when using regional muscle flaps both on ambulation and potential to power a manual wheelchair or use crutches.