Reconstruction of Unexpected Huge Chest Wall Defect after Recurrent Breast Cancer Excision Using a TRAM Flap Combined with Partial Latissimus Dorsi Muscle Flap

Copyright 2013 The Korean Society of Plastic and Reconstructive Surgeons This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited. minor wound revision was performed three times. During the 9-month postoperative follow-up, the patient had achieved normal gait patterns and urination (Fig. 3), but the patient had not recovered sexual functions. FG is thought to arise from the combination of a polymicrobial infection and microthrombosis, resulting from small subcutaneous arterioles. The organism probably passes through the Buck's fascia to spread along the planes of the dartos fascia of the scrotum and penis, Colles’ fascia of the perineum, and Scarpa’s fascia of the abdominal wall [4]. If FG is not recognized and treated early in its course, it may produce extensive defects. Because of the widespread breakdown of skin barriers in extensive FG defects, there are high risks of local and systemic infections. In addition, the physical and psychological stresses caused by extensive FG defects require a long time for complete wound bed preparation. Therefore, a single-stage reconstruction is recommended for extensive FG defects. There are various solutions for covering extensive FG defects such as skin grafts and flaps [3,5]. However, skin grafts for extensive FG defects may be unsatisfactory because of 1) frequent urinary and fecal contamination causing maceration and breakdown, and 2) the exposure of bone and vital organs such as the iliac crest and testes. Reconstruction using the free flap in extensive FG defects is restricted because of the difficulty of finding reliable recipient vessels, given the inherent potential vascular complications in the wound bed and adjacent tissues, and because the operation time can be excessively prolonged during microsurgery. The pedicled ALT flap and the gracilis myocutaneous flap can be useful choices for reconstruction of extensive FG defects involving the groin, pubic area, and scrotum, where the bone and vital organs are exposed.