Combined Free Vascularized Iliac Osteocutaneous Flap and Pedicled Pectoralis Major Myocutaneous Flap for Reconstruction of Anterior Chest Wall Full-Thickness.

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Combined Free Vascularized Iliac Osteocutaneous Flap and Pedicled Pectoralis Major Myocutaneous Flap for Reconstruction of Anterior Chest Wall Full-Thickness Defect Shih-Hsin Chang, MD, PhD, Kwang-Yi Tung, MD, Hung-Tao Hsiao, MD, Chiao-Hung Chen, MD, Hou-Keng Liu, MD The Annals of Thoracic Surgery Volume 91, Issue 2, Pages 586-588 (February 2011) DOI: 10.1016/j.athoracsur.2010.07.042 Copyright © 2011 The Society of Thoracic Surgeons Terms and Conditions

Fig 1 An infected ulcer was noted at the left anterior chest wall, and a 12- × 15-cm composite defect with the sternum and left second to seventh ribs deficiency was noted after debridement. A right thoracodorsal artery was used as the recipient artery and a 30-cm vein graft (harvested from right leg) was used. The cephalic vein was dissected down to the right cubital area (30 cm) and then turned over as the recipient vein. The Annals of Thoracic Surgery 2011 91, 586-588DOI: (10.1016/j.athoracsur.2010.07.042) Copyright © 2011 The Society of Thoracic Surgeons Terms and Conditions

Fig 2 The schema of reconstruction. An iliac osteocutaneous flap (3 × 14-cm bone segment) was harvested for reconstruction of the lower part of the defect. The bone segment was used to bridge the sternum to the left third and fourth ribs and was fixed with wire loops. The Annals of Thoracic Surgery 2011 91, 586-588DOI: (10.1016/j.athoracsur.2010.07.042) Copyright © 2011 The Society of Thoracic Surgeons Terms and Conditions

Fig 3 The skin paddle (9 × 12 cm) of the iliac osteocutaneous flap and the contralateral rotational pectoralis major muscle flap with skin grafting was used to cover the upper part of the skin defect (13 × 5 cm). The Annals of Thoracic Surgery 2011 91, 586-588DOI: (10.1016/j.athoracsur.2010.07.042) Copyright © 2011 The Society of Thoracic Surgeons Terms and Conditions

Fig 4 The postoperative computed tomography scan showed good configuration of the bone segment of the iliac osteocutaneous flap compared with the contralateral costal margin, with no compression to the heart (red arrows). Center of the body (white arrows.) The Annals of Thoracic Surgery 2011 91, 586-588DOI: (10.1016/j.athoracsur.2010.07.042) Copyright © 2011 The Society of Thoracic Surgeons Terms and Conditions