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An approach to repair of radiation necrosis of chest wall and mammary gland

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Abstract

Chest wall reconstruction following radiation no longer need be a protracted sequence of multiple stage tissue transfer with potential necrosis of the flap at each step. Muscle flaps with or without the overlying skin provide very reliable and effective methods of single-stage repair. For the anterior chest the latissimus dorsi, the rectus abdominis, and pectoralis muscles are the choices with omen turn as an alternative in salvage cases. For the posterior chest, choices are the latissimus dorsi or trapezius.

In selected patients, breast reconstruction can be offered. The use of either the rectus abdominis or latissimus dorsi musculocutaneous flap, singly or in tandem, is the current preferred choice.

Résumé

La restauration de la paroi thoracique altérée par irradiation ne nécessite plus d'avoir recours à la greffe classique avec ses multiples étapes, le greffon étant exposé à la nécrose au cours de chaque étape. Les lambaux musculaires recouverts ou non de la peau attenante et ayant conservé leur pédicule vasculaire permettent en effet de procéder avec efficacité et sécurité à une opération en un temps. En ce qui concerne la paroi antérieure, le grand dorsal, le grand droit de l'abdomen et les pectoraux représentent les greffons de choix ainsi que le grand épiploon dans les cas difficiles. En ce qui concerne la paroi postérieure, le grand dorsal et le transverse sont les éléments qui conviennent. Dans certains cas particuliers la reconstruction du sein est possible. Elle peut Être effectuée à l'aide d'un lambeau du grand droit de l'abdomen, du grand dorsal ou des 2 éléments.

Resumen

La reconstrucción de la pared torácica después de irradición ya no debe ser una prolongada secuencia de multiples transferencias escalonadas de tejidos con el peligro de necrosis potencial en cada paso. Los colgajos musculares con o sin piel significan un método confiable y efectivo de reparación en una sola etapa. Para reconstruir la pared anterior del tórax se prefiere el uso de los mÚsculos dorsal ancho, rectus abdominis y pectorales, con el epiplón mayor como alternativa en casos potencialmente curables. Para reconstruir la pared posterior se prefiere al dorsal ancho o al trapecio. En casos seleccionados se puede ofrecer la reconstrucción mamaria. La preferencia actual reside en los colgajos musculocutáneos de rectus abdominis o dorsal ancho aislados o en combinación.

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  1. Department of Surgery, Emory University Clinic, 25 Prescott Street, 30308, N.E., Atlanta, Georgia, USA

    William Sando M.D. & M. J. Jurkiewicz M.D.

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Sando, W., Jurkiewicz, M.J. An approach to repair of radiation necrosis of chest wall and mammary gland. World J. Surg. 10, 206–219 (1986). https://doi.org/10.1007/BF01658137

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