Repair strategy of chest radiation ulcer after radical mastectomy for breast cancer and its clinical effect

Du Weili; Shen Yuming; Cheng Lin; Dai Qiang; Che Kexin

doi:10.3760/cma.j.cn501225-20240315-00099

Volume 40 Issue 6

Jun. 2024

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Article Navigation > CHINESE JOURNAL OF BURNS AND WOUNDS > 2024 > 40(6): 521-528

Du WL,Shen YM,Cheng L,et al.Repair strategy of chest radiation ulcer after radical mastectomy for breast cancer and its clinical effect[J].Chin J Burns Wounds,2024,40(6):521-528.DOI: 10.3760/cma.j.cn501225-20240315-00099.

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Repair strategy of chest radiation ulcer after radical mastectomy for breast cancer and its clinical effect

doi: 10.3760/cma.j.cn501225-20240315-00099

Department of Burns, Beijing Jishuitan Hospital, Capital Medical University, Beijing 100035, China

Funds:

National Key Research and Development Program of China 2018YFA0703104

Research and Cultivation Program of Beijing Capital Hospital PX2024016

Subject Backbone of Beijing Jishuitan Hospital XKGG202209

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Corresponding author: Shen Yuming, Email: shenyuming1963@163.com
Received Date: 2024-03-15

Abstract

Abstract

Objective To explore the repair strategy of chest radiation ulcer after radical mastectomy for breast cancer and its clinical effect. Methods The study was a retrospective observational study. From September 2020 to September 2023, 27 female patients (aged 37-83 years) with chest radiation ulcers after radical mastectomy for breast cancer who met the inclusion criteria were admitted to Beijing Jishuitan Hospital Affiliated to Capital Medical University, of which 7 patients developed significant pain in the chest region. Various examinations were completed to accurately assess the presence of tumors and depth of radiation ulcers. After tumor recurrence was ruled out, the ulcer wounds were thoroughly debrided (the wound size after debridement was 8 cm×7 cm to 18 cm×18 cm). At the same time, pathological examination of the wound tissue and bacterial culture of the wound tissue/exudate samples were performed. The wound repair surgery was performed at the same time after debridement or one week after vacuum sealing drainage (VSD) treatment. Based on the location and size of the wound, the age and overall condition of the patient, as well as the principle of minimizing damage to the donor site, the most suitable tissue flap was selected to repair the wound. The donor site wound was transplanted with a split-thickness skin graft or sutured together. The level and tissue structure of radiation injury, and the type and size of transplanted tissue flap were recorded. The results of postoperative pathological examination of wound tissue and bacterial culture of wound tissue/exudate samples, pain relief, survival of tissue flap, and wound healing were recorded. During the follow-up, the shape of the tissue flap, whether the ulcer recurred, the wound healing of the donor site, and whether the abdominal wall hernia occurred in the donor site of the rectus abdominis myocutaneous flap were observed. Results Radiation injury involved ribs and costal cartilage in 21 cases, ribs, sternum, and clavicle in 4 cases, and clavicle and subclavian artery in 2 cases. Twelve patients were transplanted with rectus abdominis myocutaneous flap, eight patients with latissimus dorsi myocutaneous flap, three patients with internal thoracic artery perforator flap, three patients with superior epigastric artery perforator flap, and one patient with free deep inferior epigastric perforator flap. The size of tissue flap was 14 cm×8 cm to 20 cm×20 cm. After surgery, no tumor component was found in the pathological examination of wound tissue; 25 patients were positive and 2 patients were negative in bacterial culture results of wound tissue/exudate samples; the pain of 7 patients was completely relieved. The tissue flaps of 25 patients survived completely after surgery, and the wounds healed. Two patients had partial necrosis at the tip of the rectus abdominis myocutaneous flap, which healed after debridement and tissue flap repair. The patients were followed up for 6 months to 2 years. The appearance of the tissue flaps was good, and no ulcer recurred. The linear scar was left on the donor site, and no abdominal wall hernia occurred in the donor site of the rectus abdominis myocutaneous flap. Conclusions Thorough debridement and VSD treatment after accurate assessment of the extent of damage, and the selection of appropriate tissue flap to repair the wound based on the patient's general condition, the wound characteristics, and the principle of minimizing damage to the donor site are good repair strategies for the chest radiation ulcers after radical mastectomy for breast cancer. By using the strategies, the wounds could be closed as soon as possible, preventing ulcer recurrence and having a good prognosis.
- Thorax,
- Radiation injuries,
- Chronic disease,
- Debridement,
- Surgical flaps,
- Wound repair

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References

[1]	程琳,杜伟力,张颖,等.骶尾部慢性放射性溃疡的分期修复策略[J].中华烧伤杂志,2021,37(3):225-231.DOI: 10.3760/cma.j.cn501120-20210104-00003.
[2]	李罡,张志,李叶扬,等.颈横动脉颈段皮支皮瓣修复颈部放射性溃疡的临床效果[J].中华烧伤杂志,2021,37(12):1116-1121.DOI: 10.3760/cma.j.cn501120-20200807-00371.
[3]	杨飞,谢卫国,张伟,等.放射性溃疡严重程度分型及临床治疗分析[J].组织工程与重建外科杂志,2022,18(1):62-66.DOI: 10.3969/j.issn.1673-0364.2022.01.015.
[4]	SpałekM.Chronic radiation-induced dermatitis: challenges and solutions[J].Clin Cosmet Investig Dermatol,2016,9:473-482.DOI: 10.2147/CCID.S94320.
[5]	BorrelliMR,ShenAH,LeeGK,et al.Radiation-induced skin fibrosis: pathogenesis, current treatment options, and emerging therapeutics[J].Ann Plast Surg,2019,83(4S Suppl 1):S59-64.DOI: 10.1097/SAP.0000000000002098.
[6]	覃凤均,宁方刚,陈欣,等.26例慢性放射性溃疡的治疗分析[J].中国全科医学,2018,21(z1):232-234.DOI: 10.3969/j.issn.1007-9572.2018.z1.099.
[7]	MaX,JinZ,LiG,et al.Classification of chronic radiation-induced ulcers in the chest wall after surgery in breast cancers[J].Radiat Oncol,2017,12(1):135.DOI: 10.1186/s13014-017-0876-y.
[8]	WaghmareCM.Radiation burn--from mechanism to management[J].Burns,2013,39(2):212-219.DOI: 10.1016/j.burns.2012.09.012.
[9]	李翌,刘会攀,王姊,等.68Ga-枸橼酸PET/CT在炎症及感染疾病中的应用进展[J].国际医学放射学杂志,2020,43(2):219-223.DOI: 10.19300/j.2020.Z17466.
[10]	郁步惠,苏洪星,孙娜,等.放射性核素显像在肌肉骨骼感染中的研究进展[J].中华核医学与分子影像杂志,2021,41(9):566-573.DOI: 10.3760/cma.j.cn32182-20210713-00233.
[11]	LiuS,ZhangJ,YinH,et al.The value of ¹⁸F-FDG PET/CT in diagnosing and localising deep sternal wound infection to guide surgical debridement[J].Int Wound J,2020,17(4):1019-1027.DOI: 10.1111/iwj.13368.
[12]	HamadaM,NakaharaT,YazawaM,et al.Radiation-induced osteomyelitis/osteonecrosis of the rib: SPECT/CT imaging for successful surgical management[J].Plast Reconstr Surg Glob Open,2019,7(12):e2536.DOI: 10.1097/GOX.0000000000002536.
[13]	ZhouB,LongY,LiS,et al.Reconstruction of chronic radiation-induced ulcers in the chest wall using free and pedicle flaps[J].Front Surg,2022,9:1010990.DOI: 10.3389/fsurg.2022.1010990.
[14]	WangC,ZhangJ,LiuZ.Vacuum-assisted closure therapy combined with bi-pectoral muscle flap for the treatment of deep sternal wound infections[J].Int Wound J,2020,17(2):332-338.DOI: 10.1111/iwj.13277.
[15]	张龙城,林文彪,韦干观,等.创面准备原则在采用胸大肌皮瓣修复颈部放射性溃疡中的应用[J].中华耳鼻咽喉头颈外科杂志,2014,49(6):509-510.DOI: 10.3760/cma.j.issn.1673-0860.2014.06.015.
[16]	ChenL,ZhangS,DaJ,et al.A systematic review and meta-analysis of efficacy and safety of negative pressure wound therapy in the treatment of diabetic foot ulcer[J].Ann Palliat Med,2021,10(10):10830-10839.DOI: 10.21037/apm-21-2476.
[17]	LiX,ZhangF,LiuX,et al.Staged treatment of chest wall radiation-induced ulcer with negative pressure wound therapy and latissimus dorsi myocutaneous flap transplantation[J].J Craniofac Surg,2019,30(5):e450-e453.DOI: 10.1097/SCS.0000000000005514.
[18]	SteenvoordeP,van EngelandA,OskamJ.Vacuum-assisted closure therapy and oral anticoagulation therapy[J].Plast Reconstr Surg,2004,113(7):2220-2221.DOI: 10.1097/01.prs.0000123603.32963.11.
[19]	ZhouY,ZhangY.Single- versus 2-stage reconstruction for chronic post-radiation chest wall ulcer: a 10-year retrospective study of chronic radiation-induced ulcers[J].Medicine (Baltimore),2019,98(8):e14567.DOI: 10.1097/MD.0000000000014567.
[20]	Fernández CanedoI,Padilla EspañaL,Francisco Millán CayetanoJ,et al.Hyperbaric oxygen therapy: an alternative treatment for radiation-induced cutaneous ulcers[J].Australas J Dermatol,2018,59(3):e203-e207.DOI: 10.1111/ajd.12763.
[21]	RyanJL.Ionizing radiation: the good, the bad, and the ugly[J].J Invest Dermatol,2012,132(3 Pt 2):985-993.DOI: 10.1038/jid.2011.411.
[22]	张鲜英,刘毅,肖斌,等.慢性放射性溃疡创面的综合治疗[J].中国美容医学,2017,26(12):13-16.
[23]	宋达疆,李赞,周晓,等.不同形式横行腹直肌肌皮瓣在乳房再造和胸壁溃疡修复中的应用经验教训及对策[J].中国医师杂志,2018,20(4):511-516.DOI: 10.3760/cma.j.issn.1008-1372.2018.04.009.
[24]	王欣.带蒂腹直肌肌皮瓣修复胸壁深度放射性溃疡[J].组织工程与重建外科杂志,2020,16(4):295-297.DOI: 10.3969/j.issn.1673-0364.2020.04.008.
[25]	赵奎背阔肌、腹直肌肌皮瓣修复乳腺癌术后胸壁放射性溃疡的临床疗效对比分析南宁广西医科大学2019 赵奎.背阔肌、腹直肌肌皮瓣修复乳腺癌术后胸壁放射性溃疡的临床疗效对比分析[D].南宁:广西医科大学,2019.
[26]	陈保国,宋慧锋,许明火,等.应用对侧胸廓内动脉穿支皮瓣修复乳腺癌术后高位放射性溃疡[J].中国美容整形外科杂志,2016,27(8):452-454.DOI: 10.3969/j.issn.1673-7040.2016.08.002.
[27]	LeppardW,PomposelliT,ChangEI,et al.Internal mammary usability as recipient vessels in DIEP breast reconstruction in the setting of previous radiation[J].J Plast Reconstr Aesthet Surg,2018,71(8):1123-1128.DOI: 10.1016/j.bjps.2018.05.041.
[28]	YamamotoT,KageyamaT,SakaiH,et al.Thoracoacromial artery and vein as main recipient vessels in deep inferior epigastric artery perforator (DIEP) flap transfer for breast reconstruction[J].J Surg Oncol,2021,123(5):1232-1237.DOI: 10.1002/jso.26421.
[29]	NaraparajuV,MoslehW,AlmnajamM,et al.The utility of radiographic assessment of the internal mammary arteries in chest wall irradiated patients[J].Front Biosci (Landmark Ed),2022,27(1):30.DOI: 10.31083/j.fbl2701030.
[30]	武雷,丁英状,郝敏如,等.两种下腹部组织瓣修复四肢大面积皮肤软组织缺损后患者的腹部功能与外形[J].中华烧伤与创面修复杂志,2023,39(10):959-967.DOI: 10.3760/cma.j.cn501225-20230428-00145.

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Repair strategy of chest radiation ulcer after radical mastectomy for breast cancer and its clinical effect

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Repair strategy of chest radiation ulcer after radical mastectomy for breast cancer and its clinical effect

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