Microsurgical Chest Wall Reconstruction with Abdominal Flaps for Large Full-Thickness Oncologic Defects

Abstract Extensive full-thickness chest wall defects following oncologic tumor resection present complex reconstructive challenges, particularly in large, vessel-depleted defects. A retrospective review of patients with full-layer oncologic chest wall resection and microsurgical reconstruction with abdominal-based flaps was conducted. Demographics, comorbidities, defect characteristics, surgical techniques, complications, and outcomes were presented. Eight patients with locally advanced breast cancer, lung cancer, and recurrent desmoid fibromatosis underwent resection and reconstruction: four for curative and four for palliative intent. Defect sizes ranged from 16 cm × 14 cm to 24 cm × 16 cm (area: 224–384 cm2). Reconstruction included a combination of pedicled transverse rectus abdominis myocutaneous (TRAM) and free deep inferior epigastric artery perforator (DIEP) flaps, bilateral free DIEP flaps, and bilateral free muscle-sparing TRAM flaps, with flap sizes ranging from 28 cm × 13 cm to 36 cm × 14 cm. All flaps were transferred successfully with few complications. Microsurgical chest wall reconstruction with abdominal flaps offers substantial volume, robust vascularity, and flexible design, making them a durable alternative for complex chest wall defects.