PMC7305359_01
Preoperative views at age of 5 years. A) Upon inspiration, B) The tense and bulging lung under the skin while crying.
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The defect was felt upon inspiration (Fig. 1A) and the right lung protruded through the bony defect upon expiration; and the bulge became more prominent and tense when crying (Fig. 1B).
Preoperative CT Scan showing the skin over the pleura with no muscles across the defect (the arrow points to the defect).
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There were no pectoral muscles across the defect (both the pectoralis major and minor were absent) (Fig. 2).
Intraoperative views. A) Dissection of the skin from the pleura anteriorly. The arrow points to the exposed pleura. B) The latissimus dorsi muscle-thoraco-lumbar fascia composite flap has been dissected and tunneled anteriorly to the defect (the arrow points to the area where the thoraco-lumbar fascia has been removed).
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A longitudinal skin incision was made anteriorly over the chest wall defect and care is given not to injure the pleura while dissecting off the skin (Fig. 3A). The composite flap was then tunneled to the anterior chest wall defect as a pedicled flap (Fig. 3B).
Postoperative views at age of 16 years. A) upon inspiration, B) upon expiration. Note that there is no bulging of the lung.
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There was no bulging of the lung through the defect upon expiration, exercise or crying (Fig. 4A, B).
Postoperative CT scan showing the thick composite flap over the pleura (arrow).
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A CT scan showed the thick muscle-fascia composite flap over the pleura (Fig. 5).