Is myocutaneous flap alone sufficient for reconstruction of chest wall osteoradionecrosis?

Makboul, Mohamed; Ayyad, Mohamed A.K. Salama

doi:10.1093/icvts/ivs146

Cited by 12 publications

(9 citation statements)

References 13 publications

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“…Regarding the chest wall, Makboul et al also reported that the use of alloplastic material for structuring was not necessary, using only latissimus dorsi flaps to close the defects. However, they state that their series of five patients had undergone local radiotherapy and that this leaves the thoracic wall more rigid 12 . That same year, Sodha et al encouraged the use of only acellular dermal matrix for the correction of wall defects after resection of ribs in selected cases 13 .…”

Section: Results Results Results Resultsmentioning

confidence: 99%

Plastic surgery in chest wall reconstruction: relevant aspects - case series

Franco

Filho

Cardoso

et al. 2015

Rev. Col. Bras. Cir.

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Section: Results Results Results Resultsmentioning

confidence: 99%

Plastic surgery in chest wall reconstruction: relevant aspects - case series

Franco

Filho

Cardoso

et al. 2015

Rev. Col. Bras. Cir.

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“…Another study used LD flap without the use of either an artificial prosthesis or autologous rib to reconstruct the chest wall defect and showed no complications regarding respiratory impairment or pleural complications by Clinical and radiological follow-up and concluded that myocutaneous flaps are satisfactory to cover the chest wall defect and provide satisfactory stability to the chest wall [27].…”

Section: Discussionmentioning

confidence: 99%

Management of Post-Mastectomy Radio-Necrotic Ulcers & Osteoradionecrosis

Alaadin¹,

Boutros²,

Saber³

2019

JCT

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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.

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“…Patients with ORN can present with diverse symptomatology, ranging from occult disease to major bone destruction with soft tissue necrosis, months to years after RT [ 6 ]. Severe ORN of the ribs is exceedingly rare, with only a handful of published case reports over the past 10 years [ 7 ]. Whilst rib ORN is rare, ORN of the mandible is relatively more common owing to the higher doses delivered for head and neck cancers and the poor vascular framework of mandibular bone [ 8 ].…”

Section: Discussionmentioning

confidence: 99%

Osteoradionecrosis of the Ribs following Breast Radiotherapy

2015

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Introduction: Osteoradionecrosis (ORN) of the chest wall is a rare complication after whole-breast radiotherapy (RT). Herein, we report a case of ORN involving the underlying ribs following adjuvant whole-breast RT using standard fractionation and conduct a review of the literature. Case Report: A previously well 43-year-old female with right-sided, early-stage, node-negative breast cancer was treated with breast-conserving surgery. She subsequently underwent adjuvant whole-breast RT receiving 50 Gy in 25 fractions over 5 weeks using standard tangential photon fields with 6 MV photons followed by an electron boost of 10 Gy in 5 fractions according to International Commission on Radiation Units (ICRU) requirements. Eleven months after RT, the patient developed right lateral chest wall pain, with magnetic resonance imaging (MRI) demonstrating two fractures involving the underlying right fifth and sixth ribs associated with fatty marrow changes in the second to sixth ribs, thus raising the possibility of ORN. Treatments including hyperbaric oxygen, pentoxifylline and vitamin E were used with symptomatic improvements. There was demonstrable resolution on follow-up MRI at 2.5 years. Conclusion: The incidence of ORN utilising modern RT techniques and standard fractionation is rare. Numerous treatments are available, with variable response rates. Emerging evidence of predictive gene profiling to estimate the risk of radiation sensitivity may assist in individualising preventative strategies to mitigate the risk of ORN.

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Is myocutaneous flap alone sufficient for reconstruction of chest wall osteoradionecrosis?

Abstract: The use of myocutaneous flap in patients with chest wall defect following osteoradionecrosis is satisfactory to cover the chest wall defect and provide satisfactory stability to the chest wall.

Cited by 12 publications

References 13 publications

Plastic surgery in chest wall reconstruction: relevant aspects - case series

Plastic surgery in chest wall reconstruction: relevant aspects - case series

Management of Post-Mastectomy Radio-Necrotic Ulcers & Osteoradionecrosis

Osteoradionecrosis of the Ribs following Breast Radiotherapy

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Is myocutaneous flap alone sufficient for reconstruction of chest wall osteoradionecrosis?

Abstract: The use of myocutaneous flap in patients with chest wall defect following osteoradionecrosis is satisfactory to cover the chest wall defect and provide satisfactory stability to the chest wall.

Cited by 12 publications

References 13 publications

Plastic surgery in chest wall reconstruction: relevant aspects - case series

Plastic surgery in chest wall reconstruction: relevant aspects - case series

Management of Post-Mastectomy Radio-Necrotic Ulcers &amp; Osteoradionecrosis

Osteoradionecrosis of the Ribs following Breast Radiotherapy

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Management of Post-Mastectomy Radio-Necrotic Ulcers & Osteoradionecrosis