A simplified strategy for chest wall reconstruction: locoregional flaps as a reliable alternative in resource-limited settings

The reconstruction of complex chest wall defects resulting from advanced breast cancer poses a significant challenge in facilities lacking microsurgical expertise. This study aims to present a simplified, reliable, and easily reproducible locoregional flap strategy for these scenarios. A retrospective analysis was conducted on four female patients who underwent immediate chest wall reconstruction following resection for locally advanced breast cancer between 2020 and 2022. A standardized protocol employing regional flaps, selected based on defect size and location, was used. Core principles included meticulous preservation of the blood supply, tension-free closure, and adequate drainage. The chest wall defects ranged from 8 × 8 cm to 26.3 × 21.5 cm. The flaps used included lateral thoracic and pedicled abdominal flaps. All flaps survived completely (4/4). One patient with a massive defect experienced minor superficial skin compromise (approx. 3 cm) at the distal flap edge, which healed with conservative management. All defects were successfully addressed in a single stage, resulting in high patient satisfaction with the chest wall contour. This simplified locoregional flap strategy, which does not require microvascular anastomosis, is feasible strategy and has a short learning curve. Despite the limited number of cases, it is particularly suitable for promotion in primary hospitals or resource-limited settings, offering a practical solution for reconstructing complex chest wall defects in advanced breast cancer patients.