A novel approach to extensive chest wall reconstruction in a child

Reconstruction of extensive chest wall defects is challenging in young children. Rigid prosthetic plates, designed to prevent paradoxical respiration, do not grow with the child and may result in progressive chest and spinal deformity. Also, because of the greater proportionate size of the thorax relative to the limbs in young children, extra-thoracic soft tissue flaps may be too small for an adequate reconstruction. Here, we report reconstruction of a large chest wall defect following resection of a Ewing's sarcoma in a two-year-old boy, using Permacol® membrane supported by a diagonally translocated seventh rib and covered by a latissimus dorsi flap.