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Case Reports
. 2021 Dec;112(6):e415-e418.
doi: 10.1016/j.athoracsur.2021.03.003. Epub 2021 Mar 6.

Canyons and Volcanoes: The Effects of Radiation on the Chest Wall

Thanh Huynh Bao  1 , Manjit S Bains  1 , Farooq Shahzad  2 , Robert J Allen Jr  2 , David R Jones  1 , Gaetano Rocco  3
Affiliations
Case Reports

Canyons and Volcanoes: The Effects of Radiation on the Chest Wall

Thanh Huynh Bao et al. Ann Thorac Surg. 2021 Dec.

Abstract

Tumors involving the sternum often require complete removal of the bony structure to achieve cure and prevent recurrence. The type and extent of reconstruction must be carefully selected. Full-thickness sternal defects often necessitate semirigid or rigid biocompatible prostheses and carefully transposed myocutaneous flaps. Superimposed infection on radiation-induced cancer or osteoradionecrosis involving the sternum is also observed, and optimal treatment relies on an experienced multidisciplinary team. This report describes the successful management of 2 cases of sternal involvement after radiation: a canyonlike lesion and a volcanolike lesion.

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Figures

Figure 1.
Figure 1.
A, PET image of hypermetabolic lymphomatous mass involving the sternum, pectoralis musculature, and anterior mediastinum before treatment. B, PET after completion of radiation therapy showing osteonecrosis of the sternal body. C, Fistulous canyon-like tract from the sternum to the skin. D, Surgical specimen after partial sternectomy with resection of bilateral costal cartilages en-bloc with the sternal-cutaneous fistula.
Figure 2.
Figure 2.
A, Intraoperative picture of the anterior chest wall defect after radical removal of the sternal fistulizing osteomyelitis. B, Intraoperative picture of the defect reconstructed with biological acellular collagen matrix (Permacol). C, Intraoperative picture after soft-tissue coverage of the defect with right and left pedicled pectoralis major myocutaneous advancement flaps. D, Healed surgical site without sign of recurrent infection 3 months after operation.
Figure 3.
Figure 3.
A, Preoperative view of the volcano-appearing radiation-induced sarcoma overlying the manubrium, 34 years after radiation therapy. B, Preoperative CT showing a subcutaneous lesion, measuring 2.8×1.3 cm, overlying the manubrium. C, Postoperative result of the sternal defect reconstruction with rotational pedicled right pectoralis major myocutaneous flap after inset. D, Healed flap 4 months after operation.
See this image and copyright information in PMC

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