Split Skin Grafting the Heart: A Simple Solution for a Complex Reconstructive Challenge

Area of Science:

• Cardiovascular Surgery
• Thoracic Surgery
• Oncology

Background:

• Osteoradionecrosis (ORN) of the chest wall can arise after radiotherapy for breast cancer, leading to complex defects.
• Management of ORN requires careful consideration of patient factors, including surgical history and physiological reserve.
• Reconstructive options for large chest wall defects can be limited, especially in elderly patients.

Observation:

• An 87-year-old woman with a history of breast cancer radiotherapy developed chest wall ORN.
• Debridement of the ORN resulted in a complex defect with exposed myocardium and parietal pleura.
• The patient had a history of extensive surgeries and limited physiological reserve, complicating reconstructive choices.

Findings:

• A split skin graft (SSG) was directly applied to the exposed myocardium and parietal pleura for wound closure.
• This technique achieved stable soft tissue coverage for the complex defect.
• This represents a novel application of SSG directly onto the heart for wound management.

Implications:

• Direct application of SSG to the myocardium may be a viable reconstructive option for select cases of chest wall ORN.
• This approach can provide stable soft tissue cover in patients with limited reconstructive alternatives.
• Further research is warranted to evaluate the long-term outcomes and safety of this technique.