Musculocutaneous grafting in the treatment of irradiation-induced chest osteomyelitis

Close metadata

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

List of references:

Lingos TI, Recht A, Vicini F, Abner A, Silver B, Harris JR. Radiation pneumonitis in breast cancer patients treated with conservative surgery and radiation therapy. Int J Radiat Oncol Biol Phys. 1991;21:355-360. https://doi.org/10.1016/0360-3016(91)90782-y
Powell S, Cooke J, Parsons C. Radiation induced brachial plexus injury: follow-up of two different fractionation schedules. Radiother Oncol. 1990;18:312-320. https://doi.org/10.1016.0167-8140(90)90057-4
Kim Do Y, Kim HY, Han YS, Park JH. Chest wall reconstruction with a lateral thoracic artery perforator propeller flap for a radiation ulcer on the anterior chest. J Plast Reconstr Aesthet Surg. 2013;66:134-136. https://doi.org/10.1016/j.bjps.2012.04.046
Funayama E, Minakawa H, Otani H, et al. Effectiveness of muscle coverage to manage osteomyelitis of very late onset in the irradiated chest wall. Surg Today. 2012;42:306-311. https://doi.org/10.1007/s00595-011-0078-4
Ferreira PC, Malheiro EL, Pereira JM, Rodrigues JM, Amarante JM. Neglected chest wall radiation-induced ulcers. Breast J. 2005;11:215-216. https://doi.org/10.1111/j.1075-122X.2005.21636.x
Johansson S. Radiation induced brachial plexopathies. Acta Oncol. 2006;45:253-257. https://doi.org/10.1080/02841860600658252
Fisher B, Anderson S, Bryant J, Margolese RG, Deutsch M, Fisher ER, Jeong JH, Wolmark N. Twenty-year follow-up of a randomized trial comparing total mastectomy, lumpectom, and lumpectomy plus irradiation for treatment of invasive breast cancer. N Engl J Med. 2002;347(16):1233-1241. https://doi.org/10.1056/NEJMoa022152
Veronesi U, Cascinelli N, Mariani L, Greco M, Saccozzi R, Luini A, Aguilar M, Marubini E. Twenty-year follow-up of a randomized study comparing breast-conserving surgery with radical mastectomy for early breast cancer. N Engl J Med. 2002;347(16):1227-1232. https://doi.org/10.1056/NEJMoa020989
Veronesi U, Marubini E, Mariani L, Galimberti V, Luini A, Veronesi P, Salvadori B, Zucali R. Radiotherapy after breast-conserving surgery in small breast carcinoma: long-term results of a randomized trial. Ann Oncol. 2001;12(7):997-1003. https://doi.org/10.1023/a:1011136326943
Peleg M, Lopez EA. The treatment of osteoradionecrosis of the mandibula: the case for hyperbaric oxgen and bone graft reconstruction. J Oral Maxillofac Surg. 2006;64:956-960. https://doi.org/10.1016/j.joms.2006.02.017
Schindl A, Schindl M, Schind L. Phototherapy with low intensity laser irradiation for a chronic radiation ulcer in a patient with lupus erythematosus and diabetes mellitus. Br J Dermatol. 1997;137:840-841. https://doi.org/10.1111/j.1365-2133.1997.tb01141.x
Futran ND, Trotti A, Gwede C. Pentoxifylline in the treatment of radiation-related soft tissue injury: preliminary observations. Laryngoscope. 1997;107:391-395. https://doi.org/10.1097/00005537-199703000-00022
Dormand EL, Banwell PE, Goodacre TE. Radiotherapy and wound healing. Int Wound J. 2005;2:112-117. https://doi.org/10.1111/j.1742-4801.2005.00079.x
Goessler UR, Bugert P, Kassner S, et al. In vitro analysis of radiation-induced dermal wounds. Otolaryngol Head Neck Surg. 2010;142: 845-850. https://doi.org/10.1016/j.otohns.2010.01.033
Buglione M, Cavagnini R, Di Rosario F, et al. Oral toxicity management in head and neck cancer patients treated with chemotherapy and radiation: dental pathologies and osteoradionecrosis (Part 1) literature review and consensus statement. Crit Rev Oncol Hematol. 2016;97:131-142. https://doi.org/10.1016/j.critrevonc.2015.08.010
Stenson KM, Kunnavakkam R, Cohen EE, et al. Chemoradiation for patients with advanced oral cavity cancer. Laryngoscope. 2010;120: 93-99. https://doi.org/10.1002/lary.20716
Syed MI, Clark LJ, Adams C. Life threatening hemorrhage from osteoradionecrosis of the ribs and clavicle. Laryngoscope. 2007 Sep;117(9): 1594-1595. https://doi.org/10.1097/MLG.0b013e31806db4f3
Rice N, Polyzois I, Ekanayake K, Omer O, Stassen LF. The management of osteoradionecrosis of the jaws — a review. Surgeon. 2015;13:101-109. https://doi.org/10.1016/j.surge.2014.07.003
Delanian S, Chatel C, Porcher R, Depondt J, Lefaix JL. Complete restoration of refractory mandibular osteoradionecrosis by prolonged treatment with a pentoxifylline-tocopherol-clodronate combination (PENTOCLO): a phase II trial. Int J Radiat Oncol Biol Phys. 2011;80:832-839. https://doi.org/10.1016/j.ijrobp.2010.03.029
Korymasov EA, Medvedchikov-Ardiya MA. Treatment of post-radiation osteomyelitis of the sternum with local vacuum therapy after radical mastectomy. Oncology Bulletin of the Volga region. 2016;5(2):71-75. (In Russ).
Mehmet Ali Eryılmaz, Vahit Özmen et al. Osteoradionecrosis on the chestwall due to radiotherapy. The Journal of Breast Health. 2010;6:2.
Tansini I. Sopra il mio nuovo processo di amputazione dell mammella. Riforma Medica (Palermo). 1906;12:757.
McCraw JB, Penix JO, Baker JW, Repair of major defects of chest wall and spine with a latissimus dorsi myocutaneous flap. Plast Reconstr Surg. 1978;62:197. https://doi.org/10.1097/00006534-197808000-00007
Holmström H. The free abdominoplasty flap and its use in breast reconstruction: an experimental study and clinical case report. Scand J Plast Reconstr Surg. 1979;13(3):423-427.

Close metadata