Soft-Tissue Chest Wall Reconstruction for Secondary Angiosarcoma: Systematic Review and Case Series

This article explores secondary angiosarcomas of the breast and chest wall, defined as those developing in a previously treated radiotherapy field. Secondary angiosarcomas account for 2% of all soft-tissue sarcomas and are principally attributed to prior history of breast cancer management with adjuvant or neoadjuvant radiotherapy. The rarity of this condition results in a dearth of evidence in the literature, particularly considering reconstruction postsurgical resection. Reconstructive methods range from local flaps and graft to free tissue transfer, with no consensus on reconstructive techniques. All participants included in this study were treated at a single specialized sarcoma center over a 10-year period by the senior authors of the paper. Patients who had direct osseous involvement or defects that were closed directly were excluded from the study. A systematic review of the literature was also performed. Thirty participants were included in the case series with a mean age of 73 years (range, 31-92 years). Thirty-one articles encompassing 318 individual cases were captured in the systematic review. A range of reconstruction techniques were implemented throughout the literature and presented cases including skin grafting, local tissue advancement, pedicle flaps, and free tissue transfers. We propose a classification system, from a national center for reconstructive oncology, for the resultant defects following resection, and a reconstructive algorithm as a guide for others managing these multifaceted defects.