Anterolateral Thigh Free Flap for Complex Composite Central Chest Wall Defect Reconstruction with Extrathoracic Microvascular Anastomoses

Complex central chest wall resection defects present a challenging management problem for both thoracic and reconstructive surgeons. Although most chest wall defects can be repaired using local and regional flaps, more complicated cases require increasingly sophisticated techniques such as microsurgical free tissue transfer. This study reviews a single plastic surgeon's experience over a 4-year period with complex chest wall reconstruction using the anterolateral thigh free flap. Five female patients who underwent the above procedure between 2004 and 2007 were reviewed retrospectively. The clinicopathologic details recorded included histologic diagnosis, extent of resection, type of skeletal defect, flap size, receipt vessels, ischemia time, and flap/donor-site complications. Skeletal reconstruction used methylmethacrylate/polypropylene mesh sandwich prostheses. The indications for surgery were metastatic breast cancer (n=3), advanced primary fibrosarcoma (n=1), and extensive radionecrosis (n=1). The average surface area of the chest wall resection was 197 cm (range, 156 to 270 cm). The four patients who underwent partial sternectomy and rib resection required skeletal reconstruction and subsequent ventilatory support postoperatively in the intensive care unit. The mean anterolateral thigh flap size was 188 cm (range, 143 to 252 cm); none of the donor sites was skin grafted. There was 100 percent flap survival, and the prostheses remained fully covered in all cases after a mean follow-up of 16 months (range, 5 to 28 months). No major complications were observed. The anterolateral thigh free flap is a safe and reliable option for reconstructing complicated composite chest wall defects. It therefore provides a practical alternative when regional pedicled flap options are unavailable or inadequate.