Soft Tissue Muscle Flaps for Coverage of Chest Wall Resections

Chest wall resection is indicated most often for primary chest wall tumors but may also be required for solitary metastases, infection, or for resection of devitalized tissue following radiation. Whether the chest wall defect is reconstructed with prosthetic material or not depends on its size and location. Resections >25 cm² or resection of four or more ribs generally require some sort of rigid or flexible or prosthetic material in order to pre-serve chest wall mechanics. In most instances, it is ideal to cover any prosthetic material with healthy, well-vascularized tissue, which mitigates severe consequences if wound separation, breakdown, or infection were to occur. There are a variety of pedicled muscle flaps that can be rotated to cover most chest wall defects, of which the most commonly used are the pectoralis major and the latissimus dorsi. Both are easily harvested by general thoracic surgeons. Lesser used muscle flaps such as the rectus abdo-minis, external oblique and trapezius or flaps that require free tissue transfer usually require the expertise of a reconstructive surgeon. Thus, it is ideal to manage larger chest wall reconstructions in a multidisciplinary approach. Though frequently used for intrathoracic translocation, the omentum is less utilized for chest wall coverage, however, it can be a useful second option in cases where rotational muscle flaps are not available or have failed. This review will describe the flaps commonly used for chest wall reconstruction.