Musculocutaneous flap reconstruction of chest-wall defects: an experience with 50 patients.

Precepts derived from a review of 50 patients included (1) prior radiation of the vessel supplying the flap does not appear to have any effect on viability; (2) in an open, infected wound, use of synthetic materials adds significantly to the risk of infection and, in fact, appears to be unnecessary; (3) in full-thickness chest-wall defects, reconstruction can be accomplished in almost all cases by inset of the flap only, without need of support of fascia, ribs, or prosthetic material; and (4) in locally recurrent breast cancer, chest-wall resection is an adjunct to chemotherapy. A schematic outlining potential defects and appropriate musculocutaneous reconstruction is also presented.