Pectus excavatum and free fasciocutaneous infragluteal flap: a new technique for the correction of congenital asymptomatic chest wall deformities in adults.

Background: Pectus excavatum is typically a cosmetic congenital chest wall deformity. In most cases, it does not affect heart and lung function; therefore, because of their high rate of complications, extensive procedures need not be performed. Various alternative techniques (e.g., reconstruction with silicone prosthesis or the transverse rectus abdominis musculocutaneous flap) were introduced in asymptomatic pectus excavatum. All of these methods have their advantages but also limitations. Thus, the authors used a free fasciocutaneous infragluteal flap for reconstruction of asymptomatic pectus excavatum in selected patients. Methods: Between 2001 and 2007, six patients suffering from asymptomatic pectus excavatum underwent correction with the free fasciocutaneous infragluteal flap. The fasciocutaneous infragluteal flap is based on a constant end artery of the inferior gluteal artery. After raising of the flap and wound closure in the buttock region, the flap was adjusted to the defect using a small skin incision in the inframammary fold, and the vessels were anastomosed. Results: There were no flap losses and no major complications. One patient suffered from a sensory change at the posterior thigh in the early postoperative period that resolved completely within 2 weeks. In four cases, flap shaping or liposuction was performed to improve the aesthetic result. In the authors' final evaluation, all patients were very satisfied with the result and would undergo the procedure again. Conclusions: The authors have demonstrated for the first time the reconstruction of asymptomatic pectus excavatum with the free fasciocutaneous infragluteal flap. It is the authors' opinion that, in selected patients, this flap offers an excellent alternative to established techniques for this problem. (Plast. Reconstr. Surg. 124: 1520, 2009.)