Reconstruction of complex chest wall defects: A case report

Abstract

BACKGROUND Chronic radiative chest wall ulcers are common in patients undergoing radiation therapy. If not treated early, then symptoms such as erosion, bleeding and infection will appear on the skin. In severe cases, ulcers invade the ribs and pleura, presenting a mortality risk. Small ulcers can be repaired with pedicle flaps. Because radioactive ulcers often invade the thorax, surgeons need to remove large areas of skin and muscle, and sometimes ribs. Repairing large chest wall defects are a challenge for surgeons. CASE SUMMARY A 74-year-old female patient was admitted to our department with chest wall skin ulceration after radiation therapy for left breast cancer. The patient was diagnosed with chronic radioactive ulceration. After multidisciplinary discussion, the authors performed expansive resection of the chest wall ulcers and repaired large chest wall defects using a deep inferior epigastric perforator (DIEP) flap combined with a high-density polyethylene (HDPE) patch. The patient was followed-up 6 mo after the operation. No pigmentation or edema was found in the flap. CONCLUSION DIEP flap plus HDPE patch is one of the better treatments for radiation-induced chest wall ulcers.

In Situ Cross-Linked Collagen-Based Biological Patch Integrating Anti-Infection and Anti-Calcification Properties

“…Infection is one of the important factors limiting the application of patches. , ADM is naturally less susceptible to bacterial infection, so it has been applied more often to contaminated wounds in the clinic. , However, the mechanism of natural ADM resistant to infection is that ADM can achieve early and rapid local revascularization and has a certain porosity to support early entry of phagocytes, making it difficult for bacterial biofilms to form. , Therefore, the ADM was only less susceptible to infection rather than being able to resist infection and destroy bacteria, and it has no anti-microbial activity of its own . Antibiotics are often used in the fight against infections because of their good antibacterial effect and quick onset of action.…”

“…Infection is one of the important factors limiting the application of patches. 29,50 ADM is naturally less susceptible to bacterial infection, so it has been applied more often to contaminated wounds in the clinic. 51,52 However, the mechanism of natural ADM resistant to infection is that ADM can achieve early and rapid local revascularization and has a certain porosity to support early entry of phagocytes, making it difficult for bacterial biofilms to form.…”