[Salvage of exposed alloplastic materials in irradiated wounds - a case report].
BACKGROUND
Modern multimodal concepts of complex reconstructions and advanced wound management enlarge strategies for surgical oncological therapies. One of the mainstays of classical surgical therapy in case of exposed alloplastic materials in irradiated wounds was to remove the foreign body due to the risk of infection. This loss of integrity and function of the contaminated host bed was to allow wound healing and closure.


METHODS
We report the management of a 56-year-old female patient who developed a lyomyosarcoma at her left shoulder girdle 8 years after radiation of the left thorax because of breast cancer. After radical tumor resection and exarticulation of her left arm in the shoulder joint a necrosis of the soft tissue envelope developed, leading to an exposed alloplastic mesh. Staged debridement and continuous application of negative pressure was performed three times. Ultimate plastic coverage was performed by means of a pectoralis myocutaneous island flap from the other breast.


RESULTS
After staged debridement and repeated vacuum application excellent wound cleaning, neovascularisation, wound contraction and formation of granulation tissue within the previously irradiated tissue zone was observed. Until fourteen months postoperative wound coverage remained stable and no signs of infection were observed.


CONCLUSIONS
By means of negative pressure therapy even in radiated wounds excellent wound cleaning and sufficient formation of granulation tissue can be achieved. In some cases negative pressure therapy together with staged debridement allows reintegration of exposed and therefore potentially contaminated alloplastic meshes into new formed granulation tissue in radiated wounds respectively radiation ulcers. Thus leading to the possibility of ultimate plastic coverage.
Loos
B
B
Abteilung für Plastische und Handchirurgie, Friedrich-Alexander-Universität Erlangen-Nürnberg.
Kopp
J
J
Bach
A
A
Kneser
U
U
Polykandriotis
E
E
Hohenberger
W
W
Horch
R E
RE
D001943:Breast Neoplasms / Q000532:radiotherapy*; D003646:Debridement / Q000295:instrumentation*; D004188:Disarticulation; D004867:Equipment Design; D005260:Female; D006801:Humans; D007890:Leiomyosarcoma / Q000601:surgery*; D008838:Microcomputers; D008875:Middle Aged; D009336:Necrosis; D009381:Neoplasms, Radiation-Induced / Q000601:surgery*; D016609:Neoplasms, Second Primary / Q000601:surgery*; D009779:Occlusive Dressings; D011183:Postoperative Complications / Q000601:surgery; D019736:Prostheses and Implants; D011855:Radiodermatitis / Q000601:surgery*; D012086:Reoperation / Q000295:instrumentation; D012782:Shoulder / Q000601:surgery; D012983:Soft Tissue Neoplasms / Q000601:surgery*; D025321:Surgery, Computer-Assisted / Q000295:instrumentation; D013524:Surgical Flaps; D013526:Surgical Mesh; D013536:Suture Techniques / Q000295:instrumentation*; D013899:Thoracic Neoplasms / Q000601:surgery*; D016896:Treatment Outcome; D014618:Vacuum; D014945:Wound Healing / Q000502:physiology