The Pentagonal Modification of the Pedicled Latissimus Dorsi Myocutaneous Flap for Chest Wall Sarcoma Reconstruction

The myocutaneous latissimus dorsi is a workhorse flap, providing robust, reliable, and composite tissue for extensive chest wall resurfacing. In this paper, we will illustrate the advantages of a pentagonal design with a V-Y modification using a reconstructive case series of 5 vignettes with chest wall defects resulting from sarcoma resection, and summarise the literature on this modification. The advantages of this technique are to: (1) maximize the available skin paddle and avoid unnecessary skin bridges. (2) Maintain V-Y advancement options for the flap, rather than the conventional rotational inset. (3) Minimize the risk of failure of closure of the large donor site. (4) Allow for a broader and wider flap harvest than conventional approaches. (5) Bring nonirradiated tissue into the reconstructed defect. These advantages are important in preserving as much reconstructive local tissue as possible, particularly in cases of extensive resection, as with sarcoma, or in irradiated tissue, in which maximizing vascularity and locoregional flap-based reconstruction is a priority.