Chest wall reconstruction using an omental flap and Integra.
We present the case of a 58-year-old lady who developed radionecrosis following irradiation of the chest wall following mastectomy. The ensuing radionecrosis of the soft tissue and bony rib cage on the left side of the chest wall progressed to advanced ischaemia with secondary infection and abscess formation. Initially the patient underwent left-sided chest wall reconstruction using a right-sided pedicled TRAM flap. The flap eventually became ischaemic and necrosed over a period of 3 weeks leaving the pleura and ribs exposed. The patient underwent VAC Therapy in order to promote the formation of granulation tissue. Several weeks later the greater Omentum was harvested as a pedicled flap and transposed into the defect which was then in turn covered with Integra and a split-skin graft. Complete wound closure was obtained with this Integra-omental flap reconstructive technique.
Department of Plastic Surgery and Burns Unit, Mater Dei Hospital, Msida 2090, Malta. dunaq@maltanet.net
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D
Aquilina
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Darmanin
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J
Briffa
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D
Gatt
D001943:Breast Neoplasms / Q000532:radiotherapy / Q000601:surgery; D002809:Chondroitin Sulfates / Q000627:therapeutic use*; D003094:Collagen / Q000627:therapeutic use*; D005260:Female; D006801:Humans; D008408:Mastectomy / Q000009:adverse effects; D008875:Middle Aged; D009336:Necrosis; D009852:Omentum / Q000098:blood supply / Q000637:transplantation*; D011855:Radiodermatitis / Q000473:pathology / Q000601:surgery*; D012883:Skin Ulcer / Q000209:etiology / Q000601:surgery*; D013524:Surgical Flaps / Q000098:blood supply; D035441:Thoracic Wall / Q000601:surgery*; D020858:Tissue and Organ Harvesting / Q000379:methods; D016896:Treatment Outcome; D014945:Wound Healing / Q000528:radiation effects
C114835:integra artificial skin; D002809:Chondroitin Sulfates; D003094:Collagen