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Review
. 2017 May;27(2):171-179.
doi: 10.1016/j.thorsurg.2017.01.011. Epub 2017 Mar 1.

Surgical Management of the Radiated Chest Wall and Its Complications

Dan J Raz  1 , Sharon L Clancy  2 , Loretta J Erhunmwunsee  3
Affiliations
Review

Surgical Management of the Radiated Chest Wall and Its Complications

Dan J Raz et al. Thorac Surg Clin. 2017 May.

Abstract

Radiation to the chest wall is common before resection of tumors. Osteoradionecrosis can occur after radiation treatment. Radical resection and reconstruction can be lifesaving. Soft tissue coverage using myocutaneous or omental flaps is determined by the quality of soft tissue available and the status of the vascular pedicle supplying available myocutaneous flaps. Radiation-induced sarcomas of the chest wall occur most commonly after radiation therapy for breast cancer. Although angiosarcomas are the most common radiation-induced sarcomas, osteosarcoma, myosarcomas, rhabdomyosarcoma, and undifferentiated sarcomas also occur. The most effective treatment is surgical resection. Inoperable tumors are treated with chemotherapy, with low response rates.

Keywords: Breast cancer; Chest wall; Osteonecrosis; Radiation; Sarcoma.

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Figures

Fig. 1
Fig. 1
Image of the chest wall ulceration showing extensive fibrinous exudate, exposed ribs, and radiation changes to the skin surrounding the ulceration.
Fig. 2
Fig. 2
Intraoperative picture after chest wall resection showing bleeding soft tissue wound edges. The heart and left lung are visible in the base of the wound. The soft tissue resection extended into the axilla.
Fig. 3
Fig. 3
Chest wall is reconstructed with 4mm thick Surgimend and secured to surrounding ribs and sternum with interrupted 0-Prolene mattress sutures.
Fig. 4
Fig. 4
Intraoperative picture after latissimus dorsi and serratus anterior rotational flaps are secured for soft tissue coverage.
Fig. 5
Fig. 5
Omental flap was transposed subcutaneously after latissimus dorsi flap necrosis.
Fig. 6
Fig. 6
Postoperative image showing omental flap covered with a split-thickness skin graft harvested from the thigh.
Fig. 7
Fig. 7
Three month postoperative image showing healed skin graft over omental reconstruction.
See this image and copyright information in PMC

References

    1. Kim JH, Jenrow KA, Brown SL. Mechanisms of radiation-induced normal tissue toxicity and implications for future clinical trials. Radiation oncology journal. 2014;32(3):103–115. - PMC - PubMed
    1. Martin M, Lefaix J, Delanian S. TGF-beta1 and radiation fibrosis: a master switch and a specific therapeutic target? International journal of radiation oncology, biology, physics. 2000;47(2):277–290. - PubMed
    1. Janko M, Ontiveros F, Fitzgerald TJ, Deng A, DeCicco M, Rock KL. IL-1 generated subsequent to radiation-induced tissue injury contributes to the pathogenesis of radiodermatitis. Radiation research. 2012;178(3):166–172. - PMC - PubMed
    1. Nawroth I, Alsner J, Behlke MA, Besenbacher F, Overgaard J, Howard KA, Kjems J. Intraperitoneal administration of chitosan/DsiRNA nanoparticles targeting TNFalpha prevents radiation-induced fibrosis. Radiotherapy and oncology : journal of the European Society for Therapeutic Radiology and Oncology. 2010;97(1):143–148. - PubMed
    1. Yi A, Kim HH, Shin HJ, Huh MO, Ahn SD, Seo BK. Radiation-induced complications after breast cancer radiation therapy: a pictorial review of multimodality imaging findings. Korean journal of radiology. 2009;10(5):496–507. - PMC - PubMed

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