Chest wall reconstruction using the pectoralis major flap with dual-partitioned partially cut ribs: A useful method for preventing deformation and preserving the strength of the donor site

In some cases, skeletal and soft issue elements are required for chest wall reconstruction. Although muscle flaps and ribs are commonly used for achieving ideal reconstruction, deformation and loss of bone strength are unavoidable in such cases. In the present report, we describe a technique for chest wall reconstruction that can help avoid such donor site deformity. A 59-year-old woman with metastasis of a malignant mixed tumor in the parotid gland underwent resection from the sternoclavicular joint to the first and second ribs, including the manubrium and part of the sternum body. To achieve chest wall reconstruction, we used a pectoralis major flap along with two dual-partitioned ribs. In this modified procedure, instead of simply using the flaps with the whole ribs (which is common), we only used the anterior cortical portion of the ribs. This helped preserve the chest wall strength and prevented deformity at the donor site. At 7 months after surgery, the cut ribs in the reconstructed area and the original donor site appeared stable, without any complications, on computer tomography. Although the thickness of the bone used was half of that used with the conventional method, the skeletal strength was sufficient for her daily activities. Our modified method requires some additional effort for cutting the ribs, but the rest of the procedure involves the use of a conventional, simple rib-muscle flap. With this method, donor site deformity can be prevented, and the procedure can not only be adapted for chest wall reconstruction but also for other skeletal reconstructions that require the use of ribs.