EXTERNAL-INTERNAL OBLIQUE REVERSE BLOOD-SUPPLY MUSCULOCUTANEOUS FLAP FOR CHEST-WALL RECONSTRUCTION

A defect resulting from resection of advanced breast tumor can be quit e large, posing a difficult reconstructive challenge. A significant nu mber of such patients are found to have local recurrences after receiv ing beam radiation therapy and chemotherapy. The external oblique musc ulocutaneous flap is now considered a reliable option, with segmental blood supply from the posterior intercostal arteries. We report a 57-y ear-old man with local recurrence of breast tumor after external beam therapy. We faced a difficult challenge in performing reconstruction b ecause of (1) several previous operations that used most of the usual options and (2) the absence of recipient vessels for microsurgery, We performed an external-internal oblique musculocutaneous flap with a re verse blood supply from the lateral branches of the inferior epigastri c artery. Our use of a reverse-flow external-internal oblique flap sup ports the concept of rotating the muscles as a unit to encourage viabi lity of the denervated and relatively devascularized component.