Bostwick J, Stevenson T R, Nahai F, Hester T R, Coleman J J, Jurkiewicz M J
Ann Surg. 1984 Oct;200(4):543-53. doi: 10.1097/00000658-198410000-00015.
Major complications of radiation directed to the breast, axilla, and mediastinum were treated in 54 patients from 1974 to 1983. A classification of these complications facilitates both an understanding of the pattern of injury and the development of a treatment plan.
I. Breast necrosis; II. Radionecrosis and Chest Wall Ulceration; III. Accelerated Coronary Atherosclerosis with Median Sternotomy Wound Failure After Coronary Revascularization; IV. Brachial Plexus Pain and Paresis; V. Lymphedema and Axillary Cicatrix; VI. Radiation-induced Neoplasia. The treatment has evolved during the 10-year study period to excision of the necrotic wound, including any tumor, and closure with a transposed muscle or musculocutaneous flap of latissimus dorsi (II, III, V) or rectus abdominis (I, II, VI). This strategy reflects a change from primary use of the omentum during the first years of the study. The vascularity, oxygen and antibiotic delivery of these muscle and musculocutaneous flaps promote wound healing, usually with one operation. The transfer of these muscles has not caused significant functional deficits.
1974年至1983年期间，对54例接受乳腺、腋窝和纵隔放疗的患者出现的主要并发症进行了治疗。对这些并发症进行分类有助于理解损伤模式并制定治疗方案。
I. 乳腺坏死；II. 放射性坏死和胸壁溃疡；III. 冠状动脉搭桥术后正中胸骨切开伤口愈合不良伴加速性冠状动脉粥样硬化；IV. 臂丛神经疼痛和麻痹；V. 淋巴水肿和腋窝瘢痕；VI. 放射性肿瘤。在为期10年的研究期间，治疗方法已发展为切除坏死伤口，包括任何肿瘤，并用背阔肌（II、III、V）或腹直肌（I、II、VI）的转位肌肉或肌皮瓣进行闭合。这一策略反映了研究最初几年主要使用大网膜的情况发生了变化。这些肌肉和肌皮瓣的血管分布、氧气供应和抗生素输送促进伤口愈合，通常只需一次手术。这些肌肉的转移未导致明显的功能缺陷。
