Staged Treatment of Chest Wall Radiation-Induced Ulcer With Negative Pressure Wound Therapy and Latissimus Dorsi Myocutaneous Flap Transplantation

Abstract

Chest wall ulcer induced by postmastectomy radiation therapy (PRMT) remains challenging for plastic surgeons because of the reduced blood supply, fibrosis, and impaired cellular potential in the irradiated area. In this study, chest wall ulcer was treated with negative pressure wound therapy (NPWT) and the latissimus dorsi myocutaneous (LDM) flap reconstruction in 2 stages. A retrospective study was performed on consecutive patients with chronic radiation-induced ulcers in chest wall from June 2012 to June 2017. Surgical debridement and NPWT were performed in the first stage and the chest wall reconstructed by the LDM flap transplantation after extensive debridement in the second stage. There were 10 female patients with chest wall ulcers with a mean age of 60.3 years. The average duration of the ulcers was 21.2 months and the ulcers varied from 1 × 2 to 5 × 7 cm2. Histological examination denied any recurrent breast cancer or radiation-related malignancy. Negative pressure wound therapy was applied with 100 to 125 mm Hg negative pressure during a period of 5 to 7 days in the first stage. The LDM flap varied from 11 × 15 to 15 × 20 cm2. The mean follow-up was 25.9 months. All the flaps survived well with satisfactory appearance and there was no donor-site morbidity or ulcer recurrence during the follow-up period. The staged treatment of the chest wall radiation ulcer incorporated the benefits of NPWT and LDM flap. It is beneficial in increasing the blood and nutrient supply to the irradiated tissue, enhancing the debridement and promoting tissue healing, thus improving the flap survival and decreasing the ulcer recurrence.

Management of Coccygeal Radiation-Induced Ulcer Using Injectable Acellular Dermal Matrix Combined with Negative Pressure Wound Therapy: A Case Report

“…Large skin defects require larger flaps associated with a higher risk of flap failure and donor site morbidity [7]. Skin grafts are not a preferable option in radiation ulcers either, as lack of perfusion and tissue destruction due to radiation damage dramatically lowers graft survival rate [8]. Though the patient in our case received a skin graft, the decision was based upon the favorable healing status of the ulcer.…”

“…Numerous studies on ADM combined with NPWT have been conducted; ADM combined with NPWT showed significantly better results than NPWT alone in hypoxic environments similar to radiation ulcers [12]. There has been little discussion on radiation ulcer treatment with NPWT, and in most cases reported, NPWT was utilized only as a modality before surgery to facilitate microcirculation and removal of bacterial proliferation [8,14]. This may be due to the fact that in radiation ulcers, the area of adjacent skin affected by radiation and hence lacking stem cells is usually wider than assumed by clinicians.…”

“…This may be due to the fact that in radiation ulcers, the area of adjacent skin affected by radiation and hence lacking stem cells is usually wider than assumed by clinicians. Therefore, NPWT alone would result in limited management of radiation ulcers [8].…”

Application of Three Different Types of Pedicled Latissimus Dorsi Flaps in Repairing Nearby Deep Soft Tissue Defects: Cosmetic Result and Shoulder Functionality Evaluation in One Center

“…However, skin grafts for deep soft tissue defects are not suitable due to their poor blood supply. 9 For these defects, musculocutaneous flaps perfused by large vessels, can increase the blood supply to the defects, fill the cavity, and cover the wounds. 10 Among these, the LD flap has been greatly applied.…”

Regional flap: A reliable coverage for post‐radiation ulcer

“…However, inadequate blood supply and damaged adnexal structures usually make these treatments ineffective for post‐radiation ulcers. Recently, many clinical studies reported the efficacy and safety of NPWT for the treatment of chronic non‐healing wounds, including those caused by RT, infection, prostheses and denervation 12,13 . And long‐term NPWT helped to promote debridement and wound healing.…”