Osteoradionecrosis of the Chest Wall

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.

Radiation-induced osteoradionecrosis of the ribs in a patient with breast cancer: A case report

Osteoradionecrosis of the chest wall after radiation therapy for breast cancer is rare; however, it is one of the most severe complications of radiation treatment. Radiologically, osteoradionecrosis can manifest as a focal lucent area in bone, periostitis, sclerosis, and cortical irregularity of bones on X-ray or computed tomography; therefore, differentiation from bone metastasis can be challenging. Associated insufficiency fractures, ulceration, and skin necrosis may also occur. We encountered a patient with osteoradionecrosis in the left anterior ribs after radiation therapy for breast cancer. Chest computed tomography revealed cortical irregularity with severe sclerotic changes of the anterior arc of the left fist to the fourth ribs. The patient's skin on the left chest wall exhibited ulceration with purulent discharge. Ultrasonography of the left chest wall revealed diffuse skin thickening with hyperechoic changes in the subcutaneous fat layer of the left chest wall with calcifications. The patient underwent rib resection and chest wall reconstruction. Recognizing characteristic imaging features of osteoradionecrosis is important for radiologists to differentiate it from bone metastasis and plan appropriate treatment.

Treatment of chest wall osteoradionecrosis with a contralateral breast Y-V flap: a case report

Chest wall osteoradionecrosis, one of the most serious complications of radiation therapy for breast cancer treatment, is usually treated by wide debridement followed by coverage with a well-vascularized flap. However, the extent of radiation-induced injury and limits in performing wide resection of the injured bones often present challenges in treatment. Herein, we present our experience treating chest wall osteoradionecrosis with a contralateral breast Y-V flap in an 81-year-old woman. She was diagnosed with chest wall osteoradionecrosis and had grade 3 ptotic breasts. Redundant contralateral breast tissue was used for reconstruction to cover the wound. The flap was elevated in the subfascial plane after an inverted-T incision was made in the lower pole and inframammary fold of the contralateral breast, while preserving the perforators of the left lateral thoracic artery. The flap was spread using the Y-V advancement fashion to cover the wound. The patient was discharged 2 weeks after surgery. At 19 months postoperation, there were no complications or recurrence. The patient was satisfied with the short recovery time and surgical results. The contralateral breast Y-V flap allows simple and quick reconstruction, potentially expanding the available treatment options and therefore increasing flexibility in choosing a treatment plan for patients.