Treatment of chest wall osteoradionecrosis with contralateral breast Y-V flap: case report

Abstract

Introduction:Chest wall osteoradionecrosis(ORN) in breast cancer is one of the most serious complications of radiation therapy. Treatment requires wide debridement and coverage with a well-vascularized flap. However, the extensive radiation-induced injury, and a limit to performing wide resection of the injured bones are challaged to treatment. Herein, we present our experience with chest wall ORN treated with contralateral breast Y-V flap.Case presentationAn 81-year-old woman diagnosed with ORN of the chest wall had a severe ptotic breast. Reconstruction was planned to cover the open wound of the chest wall using redundant contralateral breast tissue. The flap was elevated in the subfascial plane after an inverted-T incision was made in the lower pole and inframammary fold of the contralateral breast while preserving the perforators of the left lateral thoracic artery. The flap was spread in a Y-V advancement fashion to cover the open wound. The patient was discharged 2 weeks after surgery following suture removal. At 19 months post-operation, there were no complications or recurrences of ulcers. The patient was satisfied with the short recovery time and the surgical results.ConclusionThe contralateral breast Y-V flap allows simple and quick reconstruction, and having more options for chest wall reconstruction will allow for a more flexible treatment plan for each patient.