RECONSTRUCTION OF RADIATION-INDUCED CHEST-WALL LESIONS

Radiation-related ulcers of the chest wall provide a great challenge t o reconstructive surgeons because of the necessity of protecting the u nderlying vital structures and the difficulty in repairing irradiated tissues. To evaluate the efficacy of treatment, 24 patients who underw ent reconstruction of radiation related ulcers of the chest wall were retrospectively reviewed. A variety of muscle and musculocutaneous fla ps as well as omentum and microvascular tissue transfers were used ta reconstruct these defects. The defects in the chest wall arose from sp ontaneous breakdown of irradiated tissue, tumor recurrence, or nonheal ing after surgical procedures performed in the irradiated field. Our t reatment protocol consisted of aggressive debridement of all affected tissues including skeletal tissues when necessary. The application of a tension free closure using a flap was then performed. Skeletal suppo rt was provided in three reconstructions. There were no mortalities, t he morbidity rate was 29% (six minor, one major complication), and the mean hospital stay was 10.9 days. None of the patients required prolo nged ventilator support. In all but 2 patients, who were left with sma ll chronic granulating nonhealing wounds, complete wound healing was a chieved. We conclude that chest wall reconstruction of radiation-relat ed ulcers can be achieved with minimal morbidity in an acceptable peri od of inpatient hospital care using a variety of vascularized tissue t ransfers.