Reconstruction of an anterior chest wall defect in a child using a latissimus dorsi muscle-thoraco-lumbar fascia composite flap – A case report

INTRODUCTION: Reconstruction of chest wall defects in children poses a challenge because the use of hard implants will impair chest wall growth. In this report, we demonstrate the reconstruction of a chest wall defect in a pediatric patient with an innovative technique using the latissimus dorsi muscle-thoraco-lumbar fascia composite flap. CASE REPORT: A 5-year old boy presented to the clinic with a congenital anterior right chest wall defect. Reconstruction was done using this composite flap. Drill holes were made in the sternum and remaining ribs at the edges of the chest wall defect. The muscle-fascia composite flap was then sutured over the defect using polypropylene sutures anchored to these drill holes. There were no post-operative complications. At final follow-up 11 years later, the chest wall depression was still present but to a lesser degree when compared to the pre-operative depression. There was no bulging of the lung through the defect. DISCUSSION: The composite flap technique was compared to other options of chest wall reconstruction in children. CONCLUSIONS: Congenital anterior chest wall defects that are not associated with breathing problems may be reconstructed in early childhood with a pedicled latissimus dorsi muscle-thoraco-lumbar fascia composite flap. The flap is rigid enough to prevent bulging of the lung though the defect and hence, it provides an adequate reconstruction. However, the remaining chest wall depression and further chest wall rigidity requires a second operation after puberty.