Published online Apr 16, 2022. doi: 10.12998/wjcc.v10.i11.3505
Peer-review started: December 15, 2021
First decision: January 26, 2022
Revised: February 3, 2022
Accepted: February 27, 2022
Article in press: February 27, 2022
Published online: April 16, 2022
Chronic radiative chest wall ulcers are common in patients undergoing radiation therapy. If not treated early, then symptoms such as erosion, bleeding and infection will appear on the skin. In severe cases, ulcers invade the ribs and pleura, presenting a mortality risk. Small ulcers can be repaired with pedicle flaps. Because radioactive ulcers often invade the thorax, surgeons need to remove large areas of skin and muscle, and sometimes ribs. Repairing large chest wall defects are a challenge for surgeons.
A 74-year-old female patient was admitted to our department with chest wall skin ulceration after radiation therapy for left breast cancer. The patient was diagnosed with chronic radioactive ulceration. After multidisciplinary discussion, the authors performed expansive resection of the chest wall ulcers and repaired large chest wall defects using a deep inferior epigastric perforator (DIEP) flap combined with a high-density polyethylene (HDPE) patch. The patient was followed-up 6 mo after the operation. No pigmentation or edema was found in the flap.
DIEP flap plus HDPE patch is one of the better treatments for radiation-induced chest wall ulcers.
Core Tip: In recent years, with the development of microsurgical techniques and breast reconstruction techniques and the wide application of autologous flap transplantation, breast surgeons have provided new ideas for the treatment of chronic radiation-induced ulcers of the chest wall. Deep inferior epigastric perforator flap combined with a high-density polyethylene patch is a promising treatment for chronic radiation-induced ulcers of the chest wall.