Multi-staged flap reconstruction for complex radiation thoracic ulcer

Rita Valença-Filipe; Ricardo Horta; Joana Costa; Jorge Carvalho; Apolino Martins; Álvaro Silva

doi:10.1016/j.ijscr.2014.11.041

Multi-staged flap reconstruction for complex radiation thoracic ulcer

Int J Surg Case Rep. 2014;5(12):1210-3. doi: 10.1016/j.ijscr.2014.11.041. Epub 2014 Nov 20.

Authors

Rita Valença-Filipe¹, Ricardo Horta², Joana Costa², Jorge Carvalho², Apolino Martins², Álvaro Silva²

Affiliations

¹ Department of Plastic, Reconstructive and Aesthetic Surgery, Maxillofacial Surgery, and Burn Unit, Centro Hospitalar de São João, Porto University Medical School, Porto, Portugal. Electronic address: ritavf@sapo.pt.
² Department of Plastic, Reconstructive and Aesthetic Surgery, Maxillofacial Surgery, and Burn Unit, Centro Hospitalar de São João, Porto University Medical School, Porto, Portugal.

Abstract

Introduction: Chest wall reconstruction due to previous radiation therapy can be challenging and complex, requiring a multidisciplinary approach.

Presentation of case: The authors present the case of a 84-year-old woman with a right chest wall radionecrosis ulcer, that was submitted to an ablative surgery resulting in a full-thickness defect of 224cm(2), firstly reconstructed with a pedicled omental flap. Due to partial flap necrosis, other debridements and chest wall multi-staged flap reconstruction were performed.

Discussion: This case highlights that the reconstructive choice should be individualized and dependent on patient and local factors. The authors advise that surgical team should work closely and be well versed in chest wall reconstruction with a variety of pedicled flaps, when a complication occurs.

Conclusion: A multi-staged flap reconstruction could be a salvage procedure for the coverage of complex, great and complicated chest wall defects due to previous radiation therapy.

Keywords: Chest wall; Flap; Radiation therapy; Radionecrosis; Thoracic ulcer.