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Ruyssinck L, De Graeve L, De Bruycker A, Monten C, Lootens L, De Ryck F, Van Landuyt K. Chest wall reconstruction for deep radiation necrosis: case report and overview of surgical options. Acta Chir Belg 2023; 123:566-572. [PMID: 35545943 DOI: 10.1080/00015458.2022.2076026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2022] [Accepted: 05/06/2022] [Indexed: 11/01/2022]
Abstract
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.
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Affiliation(s)
- Laure Ruyssinck
- Department of Plastic, Reconstructive and Aesthetic Surgery, Ghent University Hospital, Ghent, Belgium
| | - L De Graeve
- Department of Plastic, Reconstructive and Aesthetic Surgery, Ghent University Hospital, Ghent, Belgium
| | - A De Bruycker
- Department of Radiotherapy, Ghent University Hospital, Ghent, Belgium
| | - C Monten
- Department of Radiotherapy, Ghent University Hospital, Ghent, Belgium
| | - L Lootens
- Department of Thoracovascular Surgery, Ghent University Hospital, Ghent, Belgium
| | - F De Ryck
- Department of Thoracovascular Surgery, Ghent University Hospital, Ghent, Belgium
| | - K Van Landuyt
- Department of Plastic, Reconstructive and Aesthetic Surgery, Ghent University Hospital, Ghent, Belgium
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Shah NR, Pfost SS, Mao RMD, Klimberg VS. Oncoplastic reconstruction of a large chest wall defect using dual fasciocutaneous flaps: A case report. Int J Surg Case Rep 2022; 93:107010. [PMID: 35477215 PMCID: PMC8991092 DOI: 10.1016/j.ijscr.2022.107010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2022] [Revised: 03/29/2022] [Accepted: 03/31/2022] [Indexed: 11/25/2022] Open
Abstract
Introduction and importance Large chest wall defects in the context of breast cancer or its sequelae can be challenging to address. Oncoplastic techniques have been demonstrated to be safe and feasible options for immediate reconstruction. We describe the use of dual fasciocutaneous flaps for coverage following resection of a large chest wall mass in an area with a remote history of radiation therapy. Case presentation A 67-year-old woman with a distant history of bilateral mastectomies and adjuvant chemoradiation for Stage IIB triple negative invasive ductal carcinoma presented with an enlarging left chest wall mass and chronic wound. The mass was excised with adequate margins, and the resulting defect was reconstructed with two locoregional fasciocutaneous flaps. Pathology returned negative for malignancy and follow-up demonstrated viable flaps that were healing well. Clinical discussion Fasciocutaneous flaps are one of many techniques for breast reconstruction and offer advantages of a relatively superficial dissection, shorter operative time, and decreased risk of functional impairment. They are consequently an attractive option for patients with multiple comorbidities and high risk of perioperative complications. Historically used for immediate reconstruction at the time of oncologic resection, we present its successful use decades after the index cancer operation to manage a chest wall defect secondary to radiation injury. Conclusions Oncoplastic reconstruction with dual fasciocutaneous flaps is a feasible option for a large chest wall defect in the setting of previous radiation. Radiation necrosis may present late with an enlarging mass and draining wound. Excision is indicated to rule out malignancy. Oncoplastic fasciocutaneous flaps are a feasible option for wound coverage.
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Affiliation(s)
- Nikhil R Shah
- Department of Surgery, University of Texas Medical Branch, 301 University Blvd, Galveston, TX 77555, USA.
| | - Stacia S Pfost
- Department of Surgery, University of Texas Medical Branch, 301 University Blvd, Galveston, TX 77555, USA; Division of Surgical Oncology, University of Texas Medical Branch, 301 University Blvd, Galveston, TX 77555, USA
| | - Rui-Min D Mao
- Department of Surgery, University of Texas Medical Branch, 301 University Blvd, Galveston, TX 77555, USA
| | - V Suzanne Klimberg
- Department of Surgery, University of Texas Medical Branch, 301 University Blvd, Galveston, TX 77555, USA; Division of Surgical Oncology, University of Texas Medical Branch, 301 University Blvd, Galveston, TX 77555, USA; The University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd, Houston, TX 77030, USA
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Kubo K, Takei H, Hamahata A. Rhomboid Flap Reconstruction after Mastectomy for Locally Advanced Breast Cancer. J NIPPON MED SCH 2021; 88:63-70. [DOI: 10.1272/jnms.jnms.2021_88-204] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Affiliation(s)
- Kazuyuki Kubo
- Division of Breast Surgery, Saitama Cancer Center
- Department of Breast Surgery and Oncology, Nippon Medical School
| | - Hiroyuki Takei
- Department of Breast Surgery and Oncology, Nippon Medical School
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Afsharfard A, Ebrahimibagha H, Zeinalpour A. A Novel Local Transposition Flap for Lateral Breast Reconstruction After Breast Conserving Surgery. Clin Breast Cancer 2021; 21:e448-e453. [PMID: 33612372 DOI: 10.1016/j.clbc.2021.01.016] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2020] [Revised: 01/14/2021] [Accepted: 01/19/2021] [Indexed: 11/26/2022]
Abstract
BACKGROUND Breast conserving surgery (BCS) followed by radiotherapy is used for the management of early-stage breast cancers. There are different techniques to reconstruct the breast after BCS, each has its own advantages and disadvantages. In this study, we aim to present a novel local transposition flap and report the follow-up results of patients who underwent breast reconstruction using this method in the short and long term. MATERIAL AND METHODS We enrolled 100 patients who underwent BCS in the form of upper or lower outer quadrant lumpectomy with or without axillary lymph node dissection. After lumpectomy, the patients underwent breast reconstruction using the local transposition flap technique. We followed the patients for 1 year, and the satisfaction results are assessed and reported postoperation, after radiochemotherapy, and after 1 year. RESULTS The patients' mean age is 47.6 (±11.7) years, and the mean BMI is 32.4 (±2.5). The duration of hospitalization was 1 day in 96 patients and 2 days in 2 patients. There were 2 patients hospitalized for 3 days. Three patients developed seroma and there were no cases of any other complication. The surgeon and patients satisfaction surveys conducted postop, after the radiochemotherapy course, and 1 year after BCS shows that the excellent and good satisfaction rate is 85%, 85%, and 92% respectively. CONCLUSION We believe that the local transposition flap can be an excellent substitution for the existing methods in the reconstruction of the lateral side breast defects.
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Affiliation(s)
- Abolfazl Afsharfard
- Department of general surgery, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Hamed Ebrahimibagha
- Department of general surgery, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Adel Zeinalpour
- Department of general surgery, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
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Haidar Ahmad H, Nicolas G, Saliba C, Ghandour MA, Zeaiter NM, Alzein H, Kassem A, Al Akhrass MA, Kubaissi M, Rahhal H, Ibrahim N, Chahrour A. Chest Wall Reconstruction with a Bilayered Wound Matrix Mesh Following Toilet Mastectomy. AMERICAN JOURNAL OF CASE REPORTS 2019; 20:1736-1739. [PMID: 31760403 PMCID: PMC6888032 DOI: 10.12659/ajcr.915811] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Patient: Female, 43 Final Diagnosis: Metastatic breast cancer Symptoms: Breast lesion, breast tumor Medication: — Clinical Procedure: Chest wall reconstruction with a bilayered wound matrix mesh following toilet mastectomy Specialty: Surgery
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Affiliation(s)
| | - Gregory Nicolas
- Division of Surgery, Lebanese American University Medical Center - Rizk Hospital, Beirut, Lebanon
| | - Christian Saliba
- Division of Surgery, Lebanese American University Medical Center - Rizk Hospital, Beirut, Lebanon
| | | | | | - Hassan Alzein
- Division of Surgery, Saint George Hospital, Hadath, Lebanon
| | - Ali Kassem
- Division of Surgery, Saint George Hospital, Hadath, Lebanon
| | | | - Muhamed Kubaissi
- Department of Intensive Care, Saint Georges Hospital, Hadath, Lebanon
| | - Hassan Rahhal
- Department of Infectious Diseases, Saint George Hospital, Hadath, Lebanon
| | - Nada Ibrahim
- Department of Pediatric Infectious Diseases, Rafic Hariri University Hospital, Beirut, Lebanon
| | - Ahmad Chahrour
- Division of Surgery, Saint George Hospital, Hadath, Lebanon
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Kubo K, Takei H, Matsumoto H, Hamahata A. Application of a rhomboid flap for the coverage of defects after malignant breast tumor resection: A case report. Oncol Lett 2017; 14:2347-2352. [PMID: 28781673 DOI: 10.3892/ol.2017.6411] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2015] [Accepted: 04/07/2017] [Indexed: 11/05/2022] Open
Abstract
Resection for locally advanced breast cancer (LABC) or malignant phyllodes tumors may cause a large skin defect with bone exposure. Although skin grafts are frequently used to cover such defects, they can result in poor cosmetic outcomes and graft acceptance is dependent upon the condition of the recipient site. To overcome the limitations of skin grafts, various flaps have been developed to cover such defects. The present study used a rhomboid flap for the coverage of skin defects after mastectomy and breast-conservative surgery (BCS). A total of 11 patients with malignant breast cancer underwent reconstructive surgery using the rhomboid flap between September 2011 and December 2013 (mastectomy, 9 patients; BCS, 2 patients). Skin resection size, axillary lymph node dissection, bone exposure, length of surgery, wound complications and whether preoperative/postoperative adjuvant therapy was received were analyzed. The maximum size of skin defect covered with the rhomboid flap in the present study was 20×20 cm. There were no major wound complications and all patients underwent postoperative adjuvant therapy on schedule. During BCS, a portion of the flap was used for augmentation of the breast, in addition to coverage of the skin defect, which resulted in good cosmetic outcomes. The rhomboid flap can be quickly and easily fashioned, and it does not require any special instruments.
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Affiliation(s)
- Kazuyuki Kubo
- Division of Breast Surgery, Saitama Cancer Center, Saitama 362-0806, Japan
| | - Hiroyuki Takei
- Department of Breast Oncology, Nippon Medical School, Tokyo 113-8603, Japan
| | - Hiroshi Matsumoto
- Division of Breast Surgery, Saitama Cancer Center, Saitama 362-0806, Japan
| | - Atsumori Hamahata
- Division of Plastic and Reconstructive Surgery, Saitama Cancer Center, Saitama 362-0806, Japan
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Vieira RADC, da Silva KMT, de Oliveira-Junior I, de Lima MA. ITADE flap after mastectomy for locally advanced breast cancer: A good choice for mid-sized defects of the chest wall, based on a systematic review of thoracoabdominal flaps. J Surg Oncol 2017; 115:949-958. [DOI: 10.1002/jso.24619] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2016] [Accepted: 03/02/2017] [Indexed: 12/15/2022]
Affiliation(s)
- René Aloisio da Costa Vieira
- Postgraduate Program in Oncology, Barretos Cancer Hospital; Pio XII Foundation; Barretos São Paulo Brazil
- Department of Mastology and Breast Reconstruction, Barretos Cancer Hospital; Pio XII Foundation; Barretos São Paulo Brazil
| | - Katia Mathias Teixeira da Silva
- Postgraduate Program in Oncology, Barretos Cancer Hospital; Pio XII Foundation; Barretos São Paulo Brazil
- Department of Mastology and Breast Reconstruction, Barretos Cancer Hospital; Pio XII Foundation; Barretos São Paulo Brazil
| | - Idam de Oliveira-Junior
- Department of Mastology and Breast Reconstruction, Barretos Cancer Hospital; Pio XII Foundation; Barretos São Paulo Brazil
| | - Marcos Alves de Lima
- Center of Epidemiology and Statistics, Barretos Cancer Hospital; Pio XII Foundation; Barretos São Paulo Brazil
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Using local flaps in a chest wall reconstruction after mastectomy for locally advanced breast cancer. Arch Plast Surg 2015; 42:288-94. [PMID: 26015883 PMCID: PMC4439587 DOI: 10.5999/aps.2015.42.3.288] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2014] [Revised: 07/30/2014] [Accepted: 07/31/2014] [Indexed: 11/08/2022] Open
Abstract
BACKGROUND Surgical ablation for locally advanced breast cancer results in large chest wall defects, which can then be managed with local flaps or skin grafts. The purpose of this article is to evaluate the outcomes of three types of local skin flaps. METHODS Among 25 local flaps in 24 patients, 6 were bilateral advancement (BA) flaps, 9 were thoracoabdominal (TA) flaps, and 10 were thoracoepigastric (TE) flaps. Clinical outcomes were compared including complications, the need for a secondary surgical intervention, and the timing of adjuvant therapy. RESULTS The mean defect size was 436.2 cm(2). Two patients with TA flaps and 6 patients with TE flaps developed distal flap necrosis, and skin grafts were needed to treat 2 patients with TE flaps. Radiation was administered to the BA, TA, and TE patients after average postoperative durations of 28, 30, or 41 days, respectively. The incidence of flap necrosis tended to be higher in TE patients, which lead to significant delays in adjuvant radiation therapy (P=0.02). CONCLUSIONS Three types of local skin flaps can be used to treat large chest wall defects after the excision of locally advanced breast cancer. Each flap has its own merits and demerits, and selecting flaps should be based on strict indications based on the dimensions and locations of the defects.
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Cogliandro A, Cagli B, Filoni A, Cassotta G, Tenna S, Persichetti P. Expander/Implant breast reconstruction after reconstruction using an extended cutaneous thoracoabdominal flap: a case report. J Breast Cancer 2014; 16:438-41. [PMID: 24454467 PMCID: PMC3893347 DOI: 10.4048/jbc.2013.16.4.438] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2013] [Accepted: 11/07/2013] [Indexed: 11/30/2022] Open
Abstract
Many flaps have been described and are being used in the reconstruction of extensive tissue defects in the thoracic wall. The extended cutaneous thoracoabdominal flap, described in 2006, is an excellent option for chest wall reconstruction in patients with advanced breast cancer, being associated with a low morbidity rate and good functional results. The main disadvantage of this technique is the poor cosmetic outcome and the complete absence of a breast crease. We present the first case of a two-stage heterologous breast reconstruction after reconstruction using an extended cutaneous thoracoabdominal flap.
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Affiliation(s)
- Annalisa Cogliandro
- Division of Plastic, Reconstructive and Aesthetic Surgery, Campus Bio-Medico University of Rome, Rome, Italy
| | - Barbara Cagli
- Division of Plastic, Reconstructive and Aesthetic Surgery, Campus Bio-Medico University of Rome, Rome, Italy
| | - Angela Filoni
- Division of Plastic, Reconstructive and Aesthetic Surgery, Campus Bio-Medico University of Rome, Rome, Italy
| | - Gabriella Cassotta
- Division of Plastic, Reconstructive and Aesthetic Surgery, Campus Bio-Medico University of Rome, Rome, Italy
| | - Stefania Tenna
- Division of Plastic, Reconstructive and Aesthetic Surgery, Campus Bio-Medico University of Rome, Rome, Italy
| | - Paolo Persichetti
- Division of Plastic, Reconstructive and Aesthetic Surgery, Campus Bio-Medico University of Rome, Rome, Italy
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