Full-Thickness Chest Wall Defects: Comparative Evaluation of Pedicled and Free Flap Reconstructions

Abstract Background Full-thickness chest wall defects, particularly in the anterior and anterolateral regions, present significant reconstructive challenges due to their impact on respiratory mechanics, thoracic stability, and the need for robust soft tissue coverage. While various regional and free flaps are available, optimal flap selection remains case-dependent. Methods This retrospective study evaluated 9 patients who underwent reconstruction for full-thickness chest wall defects between 2018 and 2023. Patient demographics, defect characteristics, flap type, materials used for skeletal stabilization, and postoperative complications were analyzed. Results A total of 11 reconstructive procedures were performed. Most defects were tumor-related (88.9%), with an average defect size of 270.5 cm². Reconstruction involved pedicled flaps in 7 cases and free flaps in 4, with mesh reinforcement used in 90.9% and plate fixation in 72.7% of procedures. The latissimus dorsi muscle was the most frequently used regional flap. Postoperative complications occurred in 54.5% of procedures, including graft lysis, partial flap necrosis, and one case of flap loss due to cardiac arrest. Statistical analysis revealed no significant difference in complication rates between free and pedicled flaps (p = 1.0). Conclusion Both pedicled and free flaps offer reliable reconstructive options for anterior and anterolateral full-thickness chest wall defects. With careful patient selection and individualized planning, satisfactory functional and aesthetic outcomes can be achieved. However, further prospective studies are needed to evaluate long-term respiratory and oncologic outcomes.