Free flaps for anterior chest wall reconstruction

Reconstruction of full-thickness chest wall defects usually entails the use of regional pedicled myocutaneous flaps as first-choice option. As defect complexity increases and local options are not available, microsurgical reconstruction is required to transfer reliable and well-vascularized tissues from distant sites. Size, anatomic location, presence of dead spaces, and extent of eventual bone defect should be assessed for proper selection of the flap. Regional recipient vessels should be previously identified and checked in order to consider alternatively the need of extension of distant recipient vessels through arteriovenous (AV) loops or vein graft interposition.