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[Reconstruction for radionecrotic chest wall ulcer using autogenous replacements].

Masafumi Hiratsuka1, Akinori Iwasaki

  • 1Department of General Thoracic, Breast and Pediatric Surgery, School of Medicine, Fukuoka University, Fukuoka, Japan.

Kyobu Geka. the Japanese Journal of Thoracic Surgery
|April 19, 2014
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Summary

Reconstructing chest wall ulcers requires flaps with robust blood supply to prevent fatal complications. This case highlights successful reconstruction using omental and rectus abdominis flaps for radionecrosis.

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Area of Science:

  • Plastic Surgery
  • Oncology
  • Reconstructive Surgery

Background:

  • Chest wall reconstruction is crucial after oncologic surgery or radiation therapy.
  • Radionecrosis of the chest wall poses significant reconstructive challenges due to compromised blood supply.
  • Flap necrosis can lead to severe complications like pyothorax, especially with prosthetic use.

Observation:

  • A 67-year-old female patient presented with a radionecrotic chest wall ulcer post-mastectomy and radiation.
  • The ulcer exhibited advanced ischemia and secondary infection, involving necrotic ribs and surrounding tissue.
  • Surgical debridement of necrotic tissue was performed.

Findings:

  • The anterior chest wall defect was successfully reconstructed using a combined pediculed omental flap and a vertical rectus abdominis myocutaneous flap.
  • The chosen flaps provided a rich and stable blood supply, essential for overcoming radionecrosis.
  • The patient achieved a favorable outcome with no recurrence of infection or breast carcinoma.

Implications:

  • This case demonstrates the efficacy of well-vascularized flaps in managing complex chest wall radionecrosis.
  • Utilizing omental and rectus abdominis flaps offers a viable solution for preventing flap failure and associated life-threatening complications.
  • Successful reconstruction ensures improved patient quality of life and oncologic outcomes.