Background: Breast cancer is still the most common indication for chest wall irradiation, despite the advances in RTH techniques complications still occur, and the time of its occurrence vary and could take few months to many years. ORN usually manifests with pain, exposed bone, fistulae and pathological fracture and the proper management needs proper debridement and coverage by thick musculocutaneous flaps. Objective: To evaluate different techniques of surgical management of post-irradiation persistent radio-necrotic ulcer & ORN with emphasis on the outcome of each technique. Patients and methods: A retrospective study from 2010 to 2015 reviewed 20 patients subjected to post-mastectomy radiotherapy as a treatment for breast cancer in NCI Cairo, and Minia oncology center Hospital, Egypt. Cases were biopsied to exclude local recurrence. The age, sex, type of ulcer, dose of radiotherapy received and the management done for these cases were recorded. Results: Only 4 patients responded to conservative treatment in the form of repeated dressings, and 16 patients needed surgical treatment; 5 of them were treated with debridement and coverage with split thickness graft with high rate of complications reaching 80%, the other 11 patients were reconstructed with musculocutanoeus flaps, of these 7 patients were reconstructed with LD flaps with 57.14% success rate and minor complications only, the other 4 cases were reconstructed with TRAM flap with 50% success and major loss of the flap in one case that needed salvage by LD flap. Pre-operative comorbidity was found in 6 patients and all of them experienced complications while only 3 of the other 14 who had no comorbidity had postoperative complications. Conclusion: Pedicled flaps provide a good choice for reconstruction and provide chest wall support without the use of synthetic mesh.

Background: For 3 decades cytoreductive surgery (CRS) and hyperthermic intraperitoneal chemotherapy (HIPEC) has been introduced as an effective technique in treating peritoneal carcinomatosis (PC) from different primaries with promising results in selected patients .The Aim of this study is to evaluate the early and late outcomes of CRS and HIPEC in management of recurrent epithelial ovarian cancer (REOC) with PC as the first Egyptian experience. Methods:In the period between September 2009 and December 2013 we treated 42 patients with PC from REOC with CRS and HIPEC using the closed abdominal technique. The perioperative complications, toxicity grade, overall survival (OS), disease free survival (DFS), mortality rates, and effects of peritoneal carcinomatosis index (PCI), completeness of cytoreduction, patient age and tumor type and grade on survival had been reported and analyzed. Results:The mean age was 51.2±7.9 (range 34-64 years). PCI was <16 in 47.7%; 16-20 in 45.2% and >20 in 7.1%). Postoperative mortality rate was 2.38%. The mean disease free survival (DFS) was 11.9±9.75 (median 9.0; range 0-51 months), while the cumulative overall survival (OS) was 73.6% at 18 months, and 55.5% at 2 years.PCI found to be a significant risk factor when we compared PCI < 16 with PCI > 16 (p = 0.001. Completeness of cytoreduction was associated with higher OS. Age > 60 years was associated with a significantly lower OS (p = 0.003). Serous papillary tumors were associated with better survival. Low tumor grade was associated with longer OS survival with no significant difference (0. 628). Conclusion:CRS and HIPEC along with the extent of the disease and the extent of cytoreduction play a crucial role in the survival of patients with REOC, and as a technique it is feasible with acceptable morbidity, mortality (2.38%) and toxicity when good patients' selection and systematic intra operative assessment are strictly applied.