Early reconstruction of Poland's syndrome using autologous rib grafts combined with a latissimus muscle flap.

The complex chest wall deformity of Poland's Syndrome may require intervention in early childhood for missing ribs and paradoxical movement of the involved anterior chest with lung herniation. To stabilize the chest wall, we have used autologous rib grafts and prosthetic fabric to replace absent endothoracic fascia. While physiologically sound, this method does nothing for the cosmetic defect which consists of absence of the pectoralis minor and one half to two thirds of the pectoralis major muscles. Silastic implants are not satisfactory in childhood and have complications from recurrent trauma and mobility in young adults. We have had recent experience in three patients (ages 10, 14, and 16 years) with an original technique which results in chest wall stabilization and immediate cosmetic reconstruction without prostheses. The operation utilizes simultaneous rib grafts and a rotational latissimus muscle flap. The muscle not only produces a near-normal contour, but also maintains sensation and contractile function. We propose this technique as a method of choice for the correction of Poland's Syndrome and suggest that it may have wider application in children and teenagers who need soft tissue and muscle replacement of the chest wall for other reasons.