Reconstruction of full-thickness defects of the thoracic wall by myocutaneous flap transfer: latissimus dorsi compared with transverse rectus abdominis.

Ten patients with primary or recurrent cancer of the chest wall underwent full-thickness resection and immediate reconstruction of the defect by placement of an alloplastic implant and transposition of a latissimus dorsi (n = 5) or transverse rectus abdominis (n = 5) myocutaneous flap. When up to three ribs were removed, these were replaced by a reabsorbable mesh sutured to the residual rib stumps. Larger skeletal defects were stabilized by placement of a permanent mesh or polytetrafluoroethylene (PTFE) sheet. In only one case the PTFE reconstruction was reinforced by metallic implants, but that caused dehiscence of the overlying flap suture, leading to major complications and eventually death. Both the latissimus dorsi and the rectus abdominis myocutaneous flaps were ideally suited to soft tissue reconstruction. There were no appreciable complications concerning viability of the flaps, and the operating time needed for the transposition of the two flaps was similar. The rectus abdominis flap showed a distinct advantage when an absorbable mesh was to be covered, as its superior thickness minimized the risk of creating a 'flail' reconstructed chest wall. This advantage was in part counter-balanced by the more limited arc of rotation compared with the latissimus dorsi flap.