Reconstruction of complex chest wall defects: A case report.

Area of Science:

• Plastic Surgery
• Oncologic Reconstruction
• Thoracic Surgery

Background:

• Chronic radiative chest wall ulcers are a significant complication of radiation therapy, posing risks of erosion, bleeding, infection, and potentially life-threatening invasion of thoracic structures.
• Large chest wall defects resulting from ulcer resection present a considerable surgical challenge, often requiring extensive tissue removal and complex reconstruction.
• Current treatment options for smaller ulcers, such as pedicle flaps, are insufficient for extensive defects common in severe cases.

Observation:

• A case study involving a 74-year-old female patient with a chronic radioactive chest wall ulcer following radiation therapy for breast cancer is presented.
• The patient underwent expansive resection of the ulcerated area, necessitating the repair of a large chest wall defect.
• The defect was reconstructed using a combination of a deep inferior epigastric perforator (DIEP) flap and a high-density polyethylene (HDPE) patch.

Findings:

• The combined DIEP flap and HDPE patch reconstruction successfully addressed the large chest wall defect.
• Post-operative follow-up at 6 months showed no signs of flap complications such as pigmentation or edema.
• This combined approach demonstrated a favorable outcome for managing radiation-induced chest wall defects.

Implications:

• The DIEP flap combined with an HDPE patch represents a viable and effective treatment strategy for complex radiation-induced chest wall ulcers.
• This technique offers a solution for reconstructing large chest wall defects, potentially improving patient outcomes and reducing mortality risk.
• Further investigation into this combined reconstructive approach may lead to standardized treatment protocols for similar challenging cases in oncologic reconstruction.