Axillary Flap for Closure of Chest Wall Defects

Long standing burn scars can have tumors arise in them called Marjolin's Ulcers. It is important to excise these ulcers with wide surgical margins.

Often the resulting defect that occurs can not be closed primarily and tissue needs to be borrowed from one region of the body and transferred into the defect. The axillary flap can be easily rotated into close defects on the anterior chest.

This flap allows for a better contour of the chest wall skin withou a visible or palpable depression that may occur with a skin graft.

Once the anterior chest wall wound is closed, drains are placed to evacuate any fluid from beneath the wound to prevent infection.

Post-operatively, the flap allows for adequate contour of the chest and for a closed wound.

It is not uncommon for many patients to have a wound or lesion present on their body for quite sometime. Often as these lesions are wounds grow larger, it becomes more difficult to excise, clean, or close these wounds.

What it is important for patients to know, is that there is always a solution or help that they can receive from Plastic & Reconstructive surgeons to make the wound cleaner, more manageable, or possibly close with a flap.

While the reconstructive process can often take time, patients are always happier with a closed wound that they no longer need to take care of.

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Chest Wall Flap for Coverage of Exposed-Infected Elbow Hardware

Occasionally, in areas of the body where there is minimal skin laxity, orthopedic hardware can become exposed and infected. These areas where little skin laxity exists can often not tolerate the swelling associated with infection. As a result, the hardware beneath may become exposed. The Plastic & Reconstructive surgeon then borrows tissue from either an adjacent or distant site on the body to replace this tissue.

It is very important when performing flap surgery such as rotational or distant free flaps that every effort is made to contain, control, or suppress infection. Often this requires multiple washouts and debridements in the operating room to reduce the bacterial count in the wound bed.

Often a VAC dressing is placed on the wound to serve as a controled suction mechanism to remove any bacteria. Once the wound is clean, a flap is performed to cover the exposed hardware and prevent infection. In this case the chest wall skin is raised and the proximal forearm wound is brought to the chest wall.

The chest wall skin is elevated based on the intercostal vessels and perforators.

The chest wall skin is then sutured to the lateral and medial aspects of the proximal forearm defect to cover the exposed hardware.

The patient remains with his arm by his side for a range of 5 to 10 days while the flap now receives its blood supply from the forearm skin. Viability of the skin paddle can be checked by placing a clamp across the chest wall flap and occluding the blood flow. If the flap remains pink, it is viable and the chest wall flap can be transferred to the forearm.

Once the chest wall flap is divided, there is brisk bleeding from the forearm skin paddle. The open medial aspect of the wound is now closed.

Finally, the expanded skin from the chest wall can be returned to successfully close the chest wall wound.

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