Shah Nikhil R, Pfost Stacia S, Mao Rui-Min D, Klimberg V Suzanne
Department of Surgery, University of Texas Medical Branch, 301 University Blvd, Galveston, TX 77555, USA.
Department of Surgery, University of Texas Medical Branch, 301 University Blvd, Galveston, TX 77555, USA; Division of Surgical Oncology, University of Texas Medical Branch, 301 University Blvd, Galveston, TX 77555, USA.
Int J Surg Case Rep. 2022 Apr;93:107010. doi: 10.1016/j.ijscr.2022.107010. Epub 2022 Apr 1.
Large chest wall defects in the context of breast cancer or its sequelae can be challenging to address. Oncoplastic techniques have been demonstrated to be safe and feasible options for immediate reconstruction. We describe the use of dual fasciocutaneous flaps for coverage following resection of a large chest wall mass in an area with a remote history of radiation therapy.
A 67-year-old woman with a distant history of bilateral mastectomies and adjuvant chemoradiation for Stage IIB triple negative invasive ductal carcinoma presented with an enlarging left chest wall mass and chronic wound. The mass was excised with adequate margins, and the resulting defect was reconstructed with two locoregional fasciocutaneous flaps. Pathology returned negative for malignancy and follow-up demonstrated viable flaps that were healing well.
Fasciocutaneous flaps are one of many techniques for breast reconstruction and offer advantages of a relatively superficial dissection, shorter operative time, and decreased risk of functional impairment. They are consequently an attractive option for patients with multiple comorbidities and high risk of perioperative complications. Historically used for immediate reconstruction at the time of oncologic resection, we present its successful use decades after the index cancer operation to manage a chest wall defect secondary to radiation injury.
Oncoplastic reconstruction with dual fasciocutaneous flaps is a feasible option for a large chest wall defect in the setting of previous radiation.
在乳腺癌及其后遗症的背景下，处理大面积胸壁缺损具有挑战性。肿瘤整形技术已被证明是即刻重建的安全可行选择。我们描述了在有远处放疗史的区域，使用双筋膜皮瓣覆盖切除大面积胸壁肿物后的创面。
一名67岁女性，有双侧乳房切除术及辅助放化疗治疗IIB期三阴性浸润性导管癌的病史，现出现左胸壁肿物增大及慢性伤口。肿物切除时切缘足够，用两个局部筋膜皮瓣修复由此产生的缺损。病理检查结果为恶性阴性，随访显示皮瓣存活良好，愈合佳。
筋膜皮瓣是乳房重建的多种技术之一，具有解剖相对表浅、手术时间短和功能受损风险降低等优点。因此，对于有多种合并症及围手术期并发症高风险的患者来说，是一个有吸引力的选择。以往常用于肿瘤切除时的即刻重建，我们展示了在初次癌症手术后数十年成功使用该技术来处理放疗损伤继发的胸壁缺损。
对于既往放疗后出现的大面积胸壁缺损，采用双筋膜皮瓣进行肿瘤整形重建是一种可行的选择。
