CLOSURE OF MASSIVE CHEST-WALL DEFECTS AFTER FULL-THICKNESS CHEST-WALLRESECTION

We report an unusual repair of a massive chest wall defect resulting f rom resection of a chronic ulcer after radiation therapy for stage IV breast carcinoma. The defect was 690 cm(2) and included the body of th e sternum, 10 ribs, and the anterior portion of the diaphragm. Chest w all reconstruction was accomplished with multiple flaps: a pectoralis major advancement flap, a reversed abdominoplasty, an omental flap, an d a latissimus dorsi-scapular-parascapular musculofasciocutaneous (hem iback) flap. Skeletal reconstruction with prosthetic material or bone grafts was not performed in this patient. The problems associated with complex chest wall reconstructions are discussed.