Abstract The treatment of pectus excavatum in an adult
patient using a free de-epithelialized latissimus dorsi
myocutaneous flap is described. While sternal elevation
has been a standard method for the treatment of pectus
excavatum, the procedure proposed herein is an appro-
priate option for patients with mild pectus excavatum
who want to avoid invasive surgery and return to daily
activities as soon as possible.
Key words Pectus excavatum · Free flap
Pectus excavatum has usually been corrected with ster-
nal elevation or sternal turnover [2,6,8]. The preschool
years are the optimum time for this type of surgery, as it
is technically difficult and more invasive to correct the
condition in adults. Therefore, more conservative meth-
ods, such as silicone implants, have been suggested
[4,7]. Certainly silicone implantation is easily performed
and morbidity is minimal. Despite the convenience of a
silicone implant, we prefer autologous reconstruction
rather than using a foreign body.
In the following report, a free latissimus dorsi muscu-
locutaneous flap transfer for the correction of pectus ex-
cavatum in an adult patient is presented.
A 46-year-old man presented with a mild funnel chest deformity
(Fig. 1). There was no evidence of cardiopulmonary dysfunction.
He wished to have the condition corrected, but wanted to get back
to work as soon as possible. In our experience, when adult patients
with pectus excavatum are treated using the sternal elevation
method, they frequently complain of prolonged pain and dyspnea;
this problem does not arise with younger patients. Taking these
factors into consideration, it was decided to use a free de-epithe-
lialized latissimus dorsi musculocutaneous flap.
The patient was placed in a supine position, and a 5-cm longi-
tudinal skin incision was made centrally in the anterior chest. The
depressed area was dissected above the fascia. A 2.5-cm length of
right fifth costal cartilage was resected 1 cm laterally from the
sternum. The internal thoracic vessels were dissected and prepared
for anastomosis. The patient was then placed in the left lateral po-
sition. A latissimus dorsi musculocutaneous flap with a 7×33 cm
skin paddle was outlined and the whole muscle was elevated and
de-epithelialized (Fig. 2). The donor site was closed primarily.
The patient was then returned to the supine position. The skin pad-
dle of the flap was divided into two portions, and the flap was then
folded and sutured to the pectoral and abdominal fascia; the tho-
racodorsal vessels were anastomosed to the recipient vessels. The
thoracodorsal nerve was also sutured to the fifth intercostal nerve.
The transferred flap was monitored postoperatively through a
small window in the anterior chest for 5 days. The postoperative
course was uneventful, and the patient was discharged on the 14th
postoperative day. He was able to resume his normal activities
within a month, and although the flap showed signs of atrophy at
18 months postoperatively, he was pleased with the results (Fig. 3).
Sternal elevation or turnover has been the standard pro-
cedure for the treatment of pectus excavatum [2, 6, 8].
However, the operation is more complicated in older pa-
tients than in younger ones. This complexity arises be-
cause the operative field is relatively wide and the rib
cartilage stiffens as the patient grows older. This stiff-
ness makes it difficult to remodel the sternum and costal
cartilage. This extensive surgery can also affect postop-
erative pulmonary function [1, 3]. Moreover, the postsur-
gical appearance in adults is generally less satisfactory
than that obtained in children.
Simple silicone implantation has been reported in ad-
olescent patients for the reasons listed earlier [4, 7].
However, a silicone implant is a foreign body and the
safety of its use is still a matter of controversy. Ohmori
and Takada described correction of Poland’s pectoralis
major myocutaneous muscle anomaly with a pedicled la-
Y. Komuro (
) · T. Masuda · S. Kobayashi · S. Yoza · K. Ohmori
Department of Plastic and Reconstructive Surgery,
Tokyo Metropolitan Police Hospital, 2-10-41 Fujimi,
Chiyoda-ku,Tokyo 102-8161 Japan
Tel.: +81-3-3234-0849, Fax: +81-3-5276-6899
Eur J Plast Surg (1999) 22:276–278 © Springer-Verlag 1999
Y. Komuro · T. Masuda · S. Kobayashi · S. Yoza
Correction of pectus excavatum with free latissimus
dorsi musculocutaneous flap
Received: 24 June 1998 / Accepted: 8 December 1998