A denuded “turn-over” deltopectoral flap combined with a latissimus dorsi myocutaneous flap in the repair of extensive radionecrosis of the chest wall

Closure of Complex Defects in the Chest Wall with Muscle Flaps

“…Recent developments in techniques of flap surgery that have resulted from better understanding of the anatomy and design of musculocutaneous flaps have provided new possibilities for such reconstructive procedures; various ones have been described. Most major defects can usually be covered using local pedicled latissimus dorsi, pectoralis major, serratus anterior, or rectus abdominis flaps (11,(19)(20)(21)(22)(23)(24). Regional muscle flaps are preferable if they are available and if they provide enough healthy tissue.…”

An approach to repair of radiation necrosis of chest wall and mammary gland

“…Local random flaps have also fared poorly [43] even with delay [31]. The vascular anatomy of the chest wall has been elucidated and has led to pedicled skin flaps such as Bakamjian's deltopectoral flap based on the internal thoracic artery [44,45]. Tai and Hasegawa's medially based flap of abdominal wall tissue [22,46] and Baroudi's thoracoabdominal flap are based on essentially the same vascular system [47].…”

“…If this maneuver fails, or is not an option, then pedicled tissue is indicated. Not only local random, but also local pedicled, flaps are risky [44] since radiation may have compromised their vascular supply. One may have to seek distant pedicled tissue.…”