Management of Radiation Necrosis of the Chest Wall Following Mastectomy: A New Treatment Option

Rw, MacMillan; Jd, Arias; Jw, Stayman

doi:10.1097/00006534-198605000-00026

Cited by 8 publications

(7 citation statements)

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“…Furthermore, the expanded skin is expected to provide well-vascularized tissues for irradiated wounds with complications such as flap necrosis. [17,18] However, complications continue to occur, including necrosis of the skin and surgical failure. Generally, the reconstruction of radiation-induced ulcers includes both bone and soft tissue repair.…”

Section: Discussionmentioning

confidence: 99%

Single- versus 2-stage reconstruction for chronic post-radiation chest wall ulcer

Zhou¹,

Zhang

2019

Medicine

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Radiation therapy can have adverse effects on normal tissue and cause chronic ulcers. The purpose of this study was to compare breast cancer patients who underwent single-stage reconstruction with patients who underwent 2-stage reconstruction for chronic radiation-induced necrotic ulcers of the chest wall. This retrospective study comprised of 50 patients with chronic radiation-induced chest wall ulcers who underwent chest wall reconstruction in our hospital between January 2002 and January 2016. All patients developed ulcers after undergoing breast cancer surgery, followed by radiation therapy. These patients were divided into 2 groups: group A, patients who underwent debridement and reconstruction with tissue flaps simultaneously in a single-stage procedure; group B, patients who underwent debridement and omentum majus tamping in the 1st stage, followed by surgical reconstruction with skin grafting or flap transfer 2 weeks later. The postoperative complications and outcomes were evaluated and compared. These patients were followed up for 48 to 55 months (mean: 50 months), and overall survival was 98%. One patient in group A died of septicemia 5 days after the operation. Six patients in group A developed flap infection, among which 4 patients progressed to flap necrosis (group A: 6/25 vs group B: 0/25; P = .000). Compared to single-stage reconstruction, surgical reconstruction in 2 stages was safer and more effective in treating chronic radiation-induced ulcers of the chest wall, and is associated with fewer postoperative complications. The omentum majus flap was the most ideal tissue for the repair of these defects.

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Section: Discussionmentioning

confidence: 99%

Single- versus 2-stage reconstruction for chronic post-radiation chest wall ulcer

Zhou¹,

Zhang

2019

Medicine

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“…Radiation to the chest wall sometimes causes deep ulcers with osteonecrosis of the ribs and sternum bone. 19 The reconstruction of these irradiation chest ulcers must provide pleural and structural continuity to support the respiratory mechanism and a primary closure following radical ulcer resection. 20 A synthetic mesh or rib graft to reinforce the chest wall should not be used for contaminated radiation ulcers, but a thick musculocutaneous flap alone should be transferred.…”

Section: -24mentioning

confidence: 99%

“…33 Table 2 briefly summarizes various reports of the surgical reconstruction of chest wall radiation ulcers. 1,[6][7][8]10,12,14,[19][20][31][32][33][34][35][36][37] The choice of flap available for chest wall reconstruction is determined by the size and location of the tissue defect. Available axial-pattern flaps include the pectoralis major, latissimus dorsi, and upper rectus abdominal musculocutaneous flaps (Figs.…”

Section: -24mentioning

confidence: 99%

“…Furthermore, the expanded skin is expected to provide a well-vascularized tissue for the irradiated wounds as a result of the delay phenomenon. 19,20 In conclusion, axial musculocutaneous flaps, microvascular free flap transfer, and perforator flap are recommended for the resurfacing of radiation ulcers, because they provide large and wellvascularized tissues, which promote successful wound healing. The choice of pedicled or free flap is decided by the location of an ulcer and general condition of the patient.…”

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confidence: 99%

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Surgical Reconstruction of Radiation Injuries

Fujioka

2014

Advances in Wound Care

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“…Hyperbaric oxygen therapy is a conservative treatment for refractory skin ulcers after radical mastectomy and radiation therapy [4]. Tissue expansion in non-irradiated adjacent skin to cover an ulcer area nearby has also been recommended for reconstruction [5]. However, such conservative modalities are generally less effective and surgical reconstruction is required in most patients because the irradiated tissues are in…”

Section: Introductionmentioning

confidence: 99%

Incidence and Reconstruction of Chronic Radiation-Induced Chest Wall Ulceration in Postoperative Breast Cancer Patients

et al. 2020

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Background: Breast cancer patients who receive radiotherapy for postoperative tumor control are exposed to the possibility of adverse effects including osteoradionecrosis and ulceration. The purpose of this study is to explore reconstruction of ulcers according to their characteristics, and also to investigate the incidence of skin ulcers in patients who had undergone radiotherapy after modified radical mastectomy (MRM).Methods: Data of patients who underwent radiation therapy after MRM from 1979 to 2003 were collected. Demographics and radiation details were analyzed along with their reconstruction outcomes and pathologic characteristics. Effects of surgical debridement and reconstruction strategies for success were also assessed.Results: A total of 113 patients had radiotherapy after MRM in our institution, out of which nine patients (7.96%) developed ulcerations in the chest wall. Eleven patients underwent reconstructive surgery, including the nine patients who developed chest wall ulcerations and an additional two patients from other hospitals. Seven patients had thoracoepigastric flaps while three had latissimus dorsi musculocutaneous flaps and one had a perforator flap. The average initial wound size was 5.77 cm<sup>2</sup>, and this average was enlarged by 23.6 times after debridement. There was no reconstructive failure in any of the patients. Fibrosis, necrosis with ulceration, and dystrophic calcification were common pathological findings. Dystrophic calcification was found in seven of 11 cases. Additionally, ossification with bone formation was noted in three of seven cases with dystrophic calcification.Conclusion: A thorough preparation of the wound bed and reconstruction with flaps appropriate for the defect can successfully treat chronic radiation-induced ulceration.

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Management of Radiation Necrosis of the Chest Wall Following Mastectomy: A New Treatment Option

Cited by 8 publications

References 0 publications

Single- versus 2-stage reconstruction for chronic post-radiation chest wall ulcer

Single- versus 2-stage reconstruction for chronic post-radiation chest wall ulcer

Surgical Reconstruction of Radiation Injuries

Incidence and Reconstruction of Chronic Radiation-Induced Chest Wall Ulceration in Postoperative Breast Cancer Patients

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