Repair of major chest wall defects caused by recurrent lesion or radiation ulcer after radical mastectomy with delto-pectoral flap / 中华内分泌外科杂志

Objective To evaluate a repair approach to major defects of chest wall caused by recurrent lesion or radiation ulcer after radical mastectomy.Methods The delto-pectoral island flaps were applied to repair major defects of chest wall.The blood supply of the flap was from the 2nd and 3rd anterior perforator of the internal mammary artery.4 patients with defects of chest wall caused by recurrent cancer lesion and 8 patients caused by radiation ulcer received the pedicled flap after resection of lesion or ulcer.Results All the 12 flaps survived,in which flap necrosis at the distal end occurred in 1 case and it was cured after changing dress.After a follow-up of 6 monthls to 4 years,the flap healed and the cosmetic effect was satisfactory.Conclusions This method is an ideal method for repair of stage I major defects of chest wall caused by recurrent lesion and radiation ulcer after radical mastectomy.

Free Flap Coverage for Radiation Ulcer on Lumbosacral Region

Since radiation was considered as a major therapeutic modalities, chronic ulceration on lumbosacral area has been eventually generated. When the lumbosacral soft tissue defect cannot be closed with a local flap, the option of a free flap should be considered. Vascularized muscle flap is a good choice on the radiation ulcer due to chronic infection and the tissue changes of radiation effects. From October 1998 to March 2001, six patients of radiation ulcer was received microvascular transfer of five free latissimus dorsi muscle flaps and one latissimus dorsi myocutaneous flap using the superior gluteal vessel as a recipient. Patients' age ranged from 45 to 74 (mean 63.3 years of age). Mean follow-up period was 19.7months (1 to 43 months). All the flaps survived with complete recovery. One case of skin graft loss was completely healed without any further intervention. In conclusion, free muscle flap with hyperbaric oxygen therapy could be successfully applied for the treatment of radiation ulcer on lumbosacral area. It can be concluded that free muscle flap transfer with hyperbaric oxygen therapy can be a preferable therapeutic modality for radiation ulcer in lumbosacral area.