CHEST-WALL RECONSTRUCTION FOR RADIONECROSIS AFTER BREAST-CARCINOMA THERAPY

This study aimed at evaluating various reconstructive procedures for c hest wall radionecrosis after breast carcinoma therapy, Four different techniques were performed between 1973 and 1992 in 120 patients: lati ssimus dorsi musculocutaneous flap (LDF; n = 81); transposed omentum a nd split-thickness Skin graft (TGO; n = 20); fasciocutaneous flap (FCF ; n = 10), and transverse rectus abdominis musculocutaneous flap (TRAM ; n = 9). Initial dose of irradiation ranged from 60 to 110 Gy, The av erage interval between initial treatment and reconstruction was 11 yea rs. Local recurrence was suspected in 26 patients and was histological ly proven alter removal in 36 (30%). Surgical procedure results were a nalyzed by mean hospital stay (8 days for LDF vs, 52 days for TGO), ea rly (13% LDF vs, 60% TGO) and late (7% IDF vs. 35% FCF) complications, second surgery (15% LDF vs. 53% FCF), and functional and cosmetic out comes. In our experience, the LDF was the first-line flap. The TRAM wa s used to cover very large defects and when breast reconstruction was needed. When these flaps were impossible or dangerous, we performed a TGO, These three procedures have replaced FCF indications.