The purpose of this article is to review closure options for complex chest wounds in patients with locally advanced breast cancer. Experiences of the plastic and oncologic surgery teams at Moffitt Cancer Center were reviewed, and the literature researched for various surgical options of complex chest wound closure. Multiple treatment modalities exist for reconstruction of complex chest wall wounds with the external oblique and V-Y latissimus dorsi musculocutaneous advancement flaps serving as workhorses in reconstruction. Treatment of cancer has moved from simply a surgical solution to include other modalities such as hormonal therapy, chemotherapy, and radiation—the latter 2 having serious consequences for wound healing. A team approach and knowledge of available flap options are vital for closure of complex wounds in a timely manner. Appropriate planning can optimize the primary goal of the oncologic surgeon to remove the cancer and the plastic surgeon’s objective to reconstruct the defect and achieve a closed, durable wound prior to chemotherapy and radiation. We present the experience at the Moffitt Cancer Center in reconstructing challenging chest defects and review the reconstructive ladder.

ore than 20,000 individuals are estimated to be impacted by finger amputations each year. 1,2 Such injuries can have a major impact on one's livelihood and psychosocial wellbeing. Since the first digital replantation operations were performed in the 1960s, criteria for this technically demanding intervention have been constantly evolving. 3,4 Early documented outcomes of up to 90 percent success have been tempered recently by more modest outcomes of 57 percent reported by Fufa et al. [5][6][7][8] The great variability of outcomes in the cited literature demonstrates the complexity of the operative indications and the technically demanding nature of the operation itself.The decision to undergo replantation versus revision amputation must take into consideration patient-specific, injury-specific, and hospital system/care-team factors. 5,6,[9][10][11] Patient variables include age, injured hand, injury type, zone, and the method of preserving the amputated digit. 12