A 61-year-old diabetic man developed necrotizing fasciitis following blunt trauma to his right chest. The remaining defect is shown after the infection was controlled with debridement and antibiotics. Chest wall resection included pectoralis major and minor muscles and left a 15 X 18cm defect.
The reconstruction options included extensive split thickness skin graft (STSG), latissimus musculocutaneous transposition with STSG to the resulting back defect, transverse rectus abdominis musculocutaneous (TRAM) flap or free flap from a distal site. Due to the patient's poor nutritional state (albumin 3.1, Hct 30), The surgeon choose the TRAM flap for the benefit of primary healing of all sites, increased patient comfort and avoidance of the stress of healing graft donor sites. The flap was based on the left rectus abdominis muscle to avoid the risk of kinking the pedicle with folding the ipsilateral muscle.
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