Complex Posterior Chest Wall Reconstruction Using Bilateral Deep Inferior Epigastric Perforator Flaps After Failed Latissimus Dorsi Free Flap: A Case Report

ABSTRACT

Radical resection of posterior chest wall sarcomas may result in extensive composite defects exposing lung parenchyma, prosthetic material, and spinal instrumentation, while simultaneously exhausting standard pedicled reconstructive options. Salvage reconstruction after free‐flap failure in this setting remains particularly challenging and poorly described. We report the case of a 58‐year‐old patient who underwent en bloc resection of a large posterior chondrosarcoma involving ribs 6–11 and adjacent hemivertebrae, resulting in a massive full‐thickness posterior thoracic defect reconstructed with PTFE mesh and spinal instrumentation. Initial soft‐tissue coverage using a contralateral free latissimus dorsi and serratus anterior flap failed because of early arterial and venous thrombosis. Salvage reconstruction was subsequently performed using bilateral deep inferior epigastric perforator (DIEP) flaps supplied through a Y‐configured saphenous vein graft anastomosed to the thoracodorsal system. The bilateral DIEP flaps provided sufficient surface area and pedicle length extension to achieve tension‐free coverage of the near‐total posterior hemithorax defect. The salvage procedure lasted 10 h in total. Both flaps survived completely without further vascular complications, allowing timely adjuvant radiotherapy. At one‐year follow‐up, the patient demonstrated durable soft‐tissue coverage without reconstruction failure or local recurrence (Figure 3B,C). This case highlights bilateral DIEP flaps combined with Y‐configured vein‐graft extension as a feasible salvage strategy for extensive posterior chest wall defects when conventional latissimus‐based reconstructive options are unavailable or have failed.