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

Abstract

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.

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

“…poor condition [3,6]. This is because once ulceration occurs, it does not heal well, and necrotic tissue can spread much deeper and wider than what is visible.…”

“…In some cases, radiation-induced ulceration develops over 10 years after radiation [2]. Because of the ulcers' unique pathophysiology including necrosis, atrophy, fibrosis, vascular damage, carcinogenesis, and impaired cellular repair potential, healing is usually delayed and some ulcerations become chronic [3].…”

Anterior chest wall reconstruction for oncologic and non-oncologic pathology: a case series

“…We discussed the case with plastic surgeons and the infectious disease colleagues to anticipate potential intraoperative complications and mutually developed an adequate plan. We all decided not to implant synthetic materials for underlying infection and osteomyelitis (12), and therefore we unanimously considered auto-grafts the best tool for body repair in her case.…”

Reconstruction of complex chest wall defects: A case report

“…The radiation dose, radiation time and patient’s condition are the risk factors known to affect its occurrence. It has been reported that radiation doses exceeding 70 Gy/7 wk/30 fractions are prone to cause such ulcers[ 1 ]. Radiation-induced ulcers of the chest wall are secondary, progressive and irreversible, with a duration of as short as several months and as long as years or decades.…”