European Journal of Plastic Surgery

, Volume 40, Issue 2, pp 111–116 | Cite as

Microsurgical flaps in the treatment of thoracic radionecrosis: a case series

  • Valentin YusteEmail author
  • Julio Delgado
  • Javier Garcia-Tirado
  • Fernando Albiñana
  • Javier Rodrigo
Original Paper



Radionecrosis of the thoracic wall is a late complication of radiotherapy mainly found in breast cancer patients. During the treatment of severe thoracic radionecrosis, the aggressive ablation of a large amount of damaged tissue is fundamental, making the use of healthy remote tissue provided by a free flap essential. However, most of the papers focusing in the reconstruction of this entity are dated or case reports. This article is intended to present the utility and results of reconstructive microsurgical techniques in these patients.


We carried out a retrospective review of the patients who underwent microsurgical reconstruction of extensive thoracic defects associated with radionecrosis in the period 2007 to 2012 in our centre. The variables studied were sex, age, size of the lesion, type of reconstructive procedure used, the postoperative evolution of the flap and the donor area, and the length of the hospital stay.


Four patients with extensive thoracic defects associated with radionecrosis were included. After debridement, bone reconstruction was performed using a polytetrafluorethylene mesh, while soft tissue reconstruction was achieved using a free flap. One of the patients was reconstructed with a deep inferior epigastric perforator free (DIEP) flap and the rest with transverse myocutaneous gracilis (TMG) free flap. No flap-related complications were observed during the postoperative period.


The effects of radiation on soft tissues and bones are the cause of the increasing complexity of thoracic reconstruction. We believe that the use of free flaps to provide large amounts of tissue or cover particularly problematic areas can be an extremely useful tool for these patients.

Level of Evidence: Level V, therapeutic study.


Radiation therapy Microvascular surgery Chest Wall 


Compliance with ethical standards

Conflict of interest

Valentin Yuste, Julio Delgado, Javier Garcia-Tirado, Fernando Albiñana and Javier Rodrigo declare that they have no conflict of interest.

Patient consent

The authors received consent from the patients for their inclusion in the study.

Ethical standards

For this type of retrospective study a formal consent from a local ethics committee is not required.




  1. 1.
    Fehlauer F, Tribius S, Höller U et al. (2003) Long-term radiation sequelae after breast-conserving therapy in women with early-stage breast cancer: an observational study using the LENT-SOMA scoring system. Int J Radiat Oncol Biol Phys 55(3):651–658CrossRefPubMedGoogle Scholar
  2. 2.
    Gerullis H, Heuck CJ, Schneider P (2009) Breast pseudotumoral radionecrosis as a late radiation-induced injury: a case report. J Med Case Rep 3(71):1–5Google Scholar
  3. 3.
    Seyfer AE (1988) Radiation-associated lesions of the chest wall. Surg Gynecol Obstet 167(2):129–131PubMedGoogle Scholar
  4. 4.
    Bostwick J, Stevenson TR, Nahai F et al. (1984) Radiation to the breast. Complications amenable to surgical treatment. Ann Surg 200(4):543–553CrossRefPubMedPubMedCentralGoogle Scholar
  5. 5.
    Hughes LE (1976) Repair of chest wall defects after irradiation for breast cancer. Ann R Coll Surg Engl 58(2):140–143PubMedPubMedCentralGoogle Scholar
  6. 6.
    Rouanet P, Fabre JM, Tica V et al. (1995) Chest wall reconstruction for radionecrosis after breast carcinoma therapy. Ann Plast Surg 34(5):465–470CrossRefPubMedGoogle Scholar
  7. 7.
    Coudurier J, Hitier M, Ochala C et al. (2015) Use of a free antero-lateral thigh flap for two-stage reconstruction of a large thoracic defect. Ann Chir Plast Esthet 60(3):231–234CrossRefPubMedGoogle Scholar
  8. 8.
    Rüegg EM, Lantieri L, Marchac A (2012) Dual perforator propeller internal mammary artery perforator (IMAP) flap for soft-tissue defect of the contralateral clavicular area. J Plast Reconstr Aesthet Surg 65(10):1414–1417CrossRefPubMedGoogle Scholar
  9. 9.
    Banic B, Meier B, Banic A et al. (2011) Thoracic radionecrosis following repeated cardiac catheterization. Radiol Res Pract 2011:201839PubMedGoogle Scholar
  10. 10.
    Dumont T, Delaporte T, Pommier P et al. (2006) Chirurgie des radionécroses. EMC (Elsevier Masson SAS, Paris), Techniques chirurgicales – Chirurgie Plastique reconstructrice et esthétique 45–154Google Scholar
  11. 11.
    Morton ME (1986) Osteoradionecrosis: a study of the incidence in the North West of England. Br J Oral Maxillofac Surg 24:323–331CrossRefPubMedGoogle Scholar
  12. 12.
    Di Candia M, Wells FC, Malata CM (2010) Anterolateral thigh free flap for complex composite central chest wall defect reconstruction with extrathoracic microvascular anastomoses. Plast Reconstr Surg 126(5):1581–1588CrossRefPubMedGoogle Scholar
  13. 13.
    Gourari A, Ho Quoc C, Guérin N et al. (2013) Severe thoracic radionecrosis: muscle-sparing latissimus dorsi flap (MSLD. Ann Chir Plast Esthet 58(1):41–46CrossRefPubMedGoogle Scholar
  14. 14.
    Rouanet P, Jozwik M, Pujol H (1994) Divided latissimus dorsi musculocutaneous flap for chest wall radionecrosis. Ann Plast Surg 33(4):418–420CrossRefPubMedGoogle Scholar
  15. 15.
    Chiang IH, Chen SG, Wang CH (2015) Treatment of sternal wound infection using a free myocutaneous flap. Ann Thorac Surg 100(5):1907–1910CrossRefPubMedGoogle Scholar
  16. 16.
    Wechselberger G, Schoeller T (2004) The transverse myocutaneous gracilis free flap: a valuable tissue source in autologous breast reconstruction. Plast Reconstr Surg 114(1):69–73CrossRefPubMedGoogle Scholar
  17. 17.
    Bodin F, Schohn T, Dissaux C et al. (2015) Bilateral simultaneous breast reconstruction with transverse musculocutaneous gracilis flaps. J Plast Reconstr Aesthet Surg 66(1):e1–e6CrossRefGoogle Scholar
  18. 18.
    Ulusal AE, Lin CH, Lin YT et al. (2008) The use of free flaps in the management of type IIIB open calcaneal fractures. Plast Reconstr Surg 121(6):2010–2019CrossRefPubMedGoogle Scholar
  19. 19.
    Pan CH, Chuang SS, Yang JY (2007) Thirty-eight free fasciocutaneous flap transfers in acute burned-hand injuries. Burns 33(2):230–235CrossRefPubMedGoogle Scholar
  20. 20.
    Saint-Cyr M, Wong C, Oni G et al. (2012) Modifications to extend the transverse upper gracilis flap in breast reconstruction: clinical series and results. Plast Reconstr Surg 129(1):24e–36eCrossRefPubMedGoogle Scholar
  21. 21.
    Vega SJ, Sandeen SN, Bossert RP et al. (2009) Gracilis myocutaneous free flap in autologous breast reconstruction. Plast Reconstr Surg 124(5):1400–1409CrossRefPubMedGoogle Scholar
  22. 22.
    Fansa H, Schirmer S, Warnecke IC et al. (2008) The transverse myocutaneous gracilis muscle flap: a fast and reliable method for breast reconstruction. Plast Reconstr Surg 122(5):1326–1333CrossRefPubMedGoogle Scholar
  23. 23.
    Van Landuyt K, Blondeel P, Hamdi M et al. (2005) The versatile DIEP flap; its use in lower extremity reconstruction. Br J Plast Surg 58(1):2–13CrossRefPubMedGoogle Scholar
  24. 24.
    Koshima I, Soeda S (1989) Inferior epigastric artery skin flaps without rectus abdominis muscle. Br J Plast Surg 42(6):645–648CrossRefPubMedGoogle Scholar
  25. 25.
    Gill PS, Hunt JP, Guerra AB et al. (2004) 10 years retrospective review of 758 DIEP flaps for breast reconstruction. Plast Reconstr Surg:1153–1160Google Scholar
  26. 26.
    Thoma A, Veltri K, Khuthaila D et al. (2004) Comparison of the deep inferior epigastric perforator flap and free transverse rectus abdominis myocutaneous flap in postmastectomy reconstruction: a cost-effectiveness analysis. Plast Recosntr Surg 113(6):1650–1661CrossRefGoogle Scholar
  27. 27.
    Blondeel PN (1999) One hundred free DIEP flap breast reconstructions: a personal experience. Br J Plast Surg 52(2):104–111CrossRefPubMedGoogle Scholar

Copyright information

© Springer-Verlag Berlin Heidelberg 2016

Authors and Affiliations

  • Valentin Yuste
    • 1
    Email author
  • Julio Delgado
    • 1
  • Javier Garcia-Tirado
    • 2
  • Fernando Albiñana
    • 1
  • Javier Rodrigo
    • 1
  1. 1.Plastic Surgery DepartmentHospital Universitario Miguel ServetZaragozaSpain
  2. 2.Thoracic Surgery DepartmentHospital Universitario Miguel ServetZaragozaSpain

Personalised recommendations