Osteoradionecrosis of the Chest Wall

Abstract

Summary: We present the case of a 48-year-old woman with a chronic ulcer with bony erosion over the right chest wall who had undergone adjuvant chemoradiotherapy for right breast cancer 18 years previously. Preoperative computed tomography revealed a large soft tissue ulcerative lesion with bony destruction of the anterolateral aspect of the right fifth and sixth ribs. Biopsy showed no evidence of recurrent malignancy. En bloc resection including the necrotic ulcer and partial resection of the fourth to sixth ribs was performed, resulting in a chest wall defect that exposed the right diaphragm and the right, middle, and lower lobes of the lung. Synthetic mesh was used to reconstruct the rib defect and prevent paradoxical respiration. A pedicle transverse rectus abdominis musculocutaneous flap was used for soft tissue and skin reconstruction.

The Feasibility of Chest Wall Resection and Reconstruction during an Operation in Breast Cancer, Phyllodes Tumor, and Osteoradionecrosis

“…Debridement with or without rib removal or sternal resection with flap coverage are the recommended treatments. 10,11,13,23 Chest wall resection is a complex procedure that requires multimodal and multidisciplinary treatment. The significant morbidity and mortality concerns associated with treatment are the main subjects of consideration.…”

“…Due to advancements in surgical technique for repairing chest wall defects, the rate of postoperative complications has decreased substantially. 9–14 Chest wall resection provides improvement of quality of life in all patients, relieving symptoms, superimposed wound infection, and complications of tumor at the chest wall.…”

The thoracoacromial artery as the lifeboat in recipient artery deficiency in complex chest wall defect reconstruction

“…Radiotherapy is used following surgery to eradicate the residual tumoral cells but can cause damage to adjacent bones and soft tissue [2] . Management includes radical excision and covering the defect with a workhorse flap [3] , [4] , [5] , [6] . Similar cases treated with radical excision and coverage with an abdominal flap based on a perforator have been reported.…”

Treatment of chest wall osteoradionecrosis with a contralateral breast Y-V flap: a case report

“…Because of radiation-induced tissue damage in the skin and soft tissue around the necrosis, wide debridement and coverage with a well-vascularized flap are required for the treatment of osteoradionecrosis [5]. However, this is highly challenging in the chest wall for the following reasons: first, the use of local flaps is limited by the extensive radiation-induced skin and soft tissue changes around the area of necrosis.…”