Musculocutaneous grafting in the treatment of irradiation-induced chest osteomyelitis

Pechetov A.A.; Lednev A.N.; Volchansky D.A.

doi:https://doi.org/10.17116/hirurgia202008129

Pechetov A.A.

Vishnevsky Research Center for Surgery

SPIN RSCI: 8705-6005
Scopus AuthorID: 14010265400
ORCID: 0000-0002-1823-4396

Lednev A.N.

Vishnevsky National Medical Research Center of Surgery

ORCID: 0000-0002-3039-1183

Volchansky D.A.

Vishnevsky Research Center for Surgery

SPIN RSCI: 7488-4958
Scopus AuthorID: 57211681517
ORCID: 0000-0002-5947-3211

Musculocutaneous grafting in the treatment of irradiation-induced chest osteomyelitis

Authors:

Pechetov A.A., Lednev A.N., Volchansky D.A.

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Journal: Pirogov Russian Journal of Surgery. 2020;(8): 29‑34

DOI: 10.17116/hirurgia202008129

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To cite this article:

Pechetov AA, Lednev AN, Volchansky DA. Musculocutaneous grafting in the treatment of irradiation-induced chest osteomyelitis. Pirogov Russian Journal of Surgery. 2020;(8):29‑34. (In Russ.)
https://doi.org/10.17116/hirurgia202008129

Подписка 2026 Хирургия. Журнал им. Н.И. Пирогова (Pirogov Russian Journal of Surgery)

Использование инфографики авторами научных работ

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Abstract:

OBJECTIVE

To report our own experience of one-stage surgical treatment of irradiation-induced osteomyelitis as a complication of radiotherapy for breast cancer (BC).

MATERIAL AND METHODS

The study included 25 patients with irradiation-induced chest osteomyelitis after previous radiotherapy for breast cancer. All patients were examined according to the same protocol. One-stage surgery with full-thickness resection of affected tissues and plastic closure of the wound was performed depending on localization of lesion and availability of plastic material.

RESULTS

Follow-up period ranged from 18 to 110 months (median 48 (19; 52) months). Complications were assessed according to Clavien—Dindo classification. Complications followed by antibacterial therapy and/or local treatment were observed in 8 (32%) out of 25 patients (95% CI 11.5—43.4). Marginal necrosis of musculoskeletal flap was registered in 4 (16%) patients. One (4%) patient required redo thoracomyoplasty after excision of necrotic tissues of musculocutaneous flap due to extensive tissue defect. Total necrosis of musculocutaneous flap was not noted. There were no fatal outcomes. Mean length of hospital-stay was 13 (10; 27) days in the group of musculocutaneous flap from latissimus dorsi muscle and 11 days (7; 24) in the group of rectus abdominis muscle. Good and satisfactory treatment outcomes after one-stage surgical treatment were achieved in 24 (96%) out of 25 patients (95% CI: 75—97.8).

CONCLUSION

Irradiation-induced chest osteomyelitis is still actual problem despite an improvement of modern medical equipment and accumulation of experience in radiotherapy. Surgery is preferable method of treatment. Comprehensive examination including contrast-enhanced chest CT with 3D reconstruction and Doppler ultrasound of vascular pedicle is valuable to determine type of resection and plastic technique. Simultaneous approach with resection and plastic closure of the wound is preferred for irradiation-induced chest osteomyelitis if sufficient amount of plastic material is available and contraindications for reconstructive surgery are absent.

Keywords:

irradiation-induced osteomyelitis

irradiation-induced necrosis

full-thickness muscular repair

flap of latissimus dorsi muscle

flap of rectus abdominis muscle

Authors:

Pechetov A.A.

Vishnevsky Research Center for Surgery

SPIN RSCI: 8705-6005
Scopus AuthorID: 14010265400
ORCID: 0000-0002-1823-4396

Lednev A.N.

Vishnevsky National Medical Research Center of Surgery

ORCID: 0000-0002-3039-1183

Volchansky D.A.

Vishnevsky Research Center for Surgery

SPIN RSCI: 7488-4958
Scopus AuthorID: 57211681517
ORCID: 0000-0002-5947-3211

Received:

10.10.2019

Accepted:

04.11.2019

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References:

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