Reconstruction of an anterior chest wall radionecrosis defect by a contralateral latissimus dorsi flap: A case report

Chest wall reconstruction for deep radiation necrosis: case report and overview of surgical options

INTRODUCTION

To report a case of radiation necrosis after reirradiation for breast cancer and the difficulties encountered when treating these complex cases.

PATIENTS AND METHODS

We present an 86-year-old woman with a history of right-sided intraductal breast cancer treated with a right mastectomy followed by local adjuvant radiotherapy (50 Gray). Twelve years later, she was diagnosed with a local recurrence in the mastectomy scar which was treated with local resection (including resection of rib four) and adjuvant radiotherapy up to 32 Gray. In July 2020 she presents at the Department of Plastic and Reconstructive Surgery with a chronic ulcer on the right-sided hemithorax.

RESULTS

A multi-staged, multidisciplinary approach was necessary to secure lasting coverage of the extensive defect.

CONCLUSION

Thoracic radiation necrosis should be subject to a multidisciplinary approach (plastic and thoracic surgeons) pre-, per-, and post-operatively. Each case may require a different surgical approach depending on the size and depth of the defect, patients' age, comorbidities, and previous medical treatment.

The thoracoacromial artery as the lifeboat in recipient artery deficiency in complex chest wall defect reconstruction

INTRODUCTION AND IMPORTANCE

Reconstruction of chest wall defects is a complex procedure requiring an accurate understanding of the complete anatomy of the chest wall to deal with challenging defects. This report investigates the use of the thoracoacromial artery and cephalic vein as recipient vessels in a musculocutaneous latissimus dorsi free flap to cover the large chest wall defect resulting from post-radiation necrosis for breast cancer.

CASE PRESENTATION

A 25-year-old woman with established necrotic osteochondritis of the left side ribs following radiotherapy in breast cancer management was admitted for reconstructing the violated chest wall. The contralateral latissimus dorsi muscle was selected as an alternative to the previously used ipsilateral muscle. The thoracoacromial artery was the only one available as a recipient artery with a successful outcome.

CLINICAL DISCUSSION

Breast cancer is the most common indication for radiotherapy. Osteoradionecrosis can present months to years after radiation with deep ulcers and major bone destruction with soft tissue necrosis. Large defect reconstruction is sometimes challenging due to lack of recipient artery and vein because of previous unsuccessful interventions. Thoracoacromial artery and its branches can be recommended as a good alternative recipient artery.

CONCLUSION

The Thoracoacromial artery may aid surgeons in achieving successful anastomoses in difficult thoracic defects.

[Use of pedicled dorsal muscle flap combined with negative pressure therapy in the management of postpneumonectomy septic complications]

SUBJECT

The objective of this study is to report our experience in the management of septic complications arising from pulmonary resection surgery by placing a pedicled upper back muscle flap associated with dressings by therapy. Negative pressure in all patients supported in our center from November 2015 to March 2018.

MATERIAL AND METHODS

Characteristics of fourteen patients with a pedicled dorsal muscle flap in the context of chronic empyema associated with bronchopulmonary fistula were identified. Flap placement time, complications, and success rate were assessed.

RESULTS

The median flap placement after completion of the open window thoracostomy was 19days [3-65]. The median healing time was 3months. Healing was definitively achieved in 12 patients, a success rate of 86%.

CONCLUSION

Through this series we have shown that our coverage by pneumonectomy cavity coverage with an early dorsal muscle flap associated with negative pressure therapy, has a similar mortality rate and success rate to those found in the literature.