INTRATHORACIC FREE FLAPS

The utility of pedicled muscle flaps transposed into the thoracic cavi ty to reconstruct complex intrathoracic defects has been well document ed. However, in some patients, local chest-wall muscles have already b een either sacrificed or transected by previous thoracotomies and are not available for reconstruction. In these patients, we have successfu lly employed microvascular techniques to transfer distant muscle flaps into the thoracic cavity. Seven patients with complex intrathoracic d efects were reconstructed with three latissimus dorsi, one omental, an d three rectus abdominis free flaps. In each case, the microvascular a nastomosis was extrathoracic, with the flap transposed into the thorac ic cavity. Each of the flaps was revascularized successfully. Four of the five bronchopleural fistulas were sealed, with the remaining patie nt continuing to demonstrate a reduced but persistent air leak. No inf ections were encountered, and each flap transfer resulted in a healed wound. When local muscle flaps are not available to reconstruct comple x intrathoracic wounds, microvascular transfer of distant muscle flaps can provide abundant well-vascularized tissue for reconstruction of a ny portion of the thoracic cavity. Versatility is afforded in flap sel ection and recipient vessel site location, making this technique an im portant option in the treatment of these difficult wounds.