title: Effectiveness of muscle coverage to manage osteomyelitis of very late onset in the irradiated chest wall.
abstract: Radiation therapy for breast cancer has improved survival rates; however, a consequence of this is treatment-induced complications in longer-living patients. Decades after chest wall irradiation, very late onset radiation-induced osteomyelitis can develop, caused by osteoradionecrosis. This may lead to the development of small, but very refractory, skin ulcers. Many reports recommend well-vascularized tissue coverage after appropriate debridement for irradiation ulcers; however, when the ulcers are of very late onset, this sometimes causes recurrence of ulceration in non-muscle-covered areas after flap transfer. Thus, for very late onset cases, we propose treatment with an absolute muscle flap to cover both the obviously infected focus and the surrounding irradiated area. A muscle flap consisting of the entire latissimus dorsi, the shape of which is very large in the horizontal direction, satisfies this requirement. Latissimus dorsi muscle coverage for the treatment of very late onset osteomyelitis should be reappraised.
authors.affiliation: Department of Plastic and Reconstructive Surgery, Hokkaido Cancer Center, Sapporo, Japan. emi-f@bc.iij4u.or.jp
authors.forename: Emi
authors.initials: E
authors.lastname: Funayama
authors.forename: Hidehiko
authors.initials: H
authors.lastname: Minakawa
authors.forename: Hidekazu
authors.initials: H
authors.lastname: Otani
authors.forename: Akihiko
authors.initials: A
authors.lastname: Oyama
authors.forename: Hiroshi
authors.initials: H
authors.lastname: Furukawa
authors.forename: Toshihiko
authors.initials: T
authors.lastname: Hayashi
authors.forename: Noriko
authors.initials: N
authors.lastname: Saito
authors.forename: Akira
authors.initials: A
authors.lastname: Saito
authors.forename: Yuhei
authors.initials: Y
authors.lastname: Yamamoto
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001943:Breast Neoplasms / Q000532:radiotherapy*; D005260:Female; D006801:Humans; D008875:Middle Aged; D010019:Osteomyelitis / Q000209:etiology / Q000601:surgery*; D010025:Osteoradionecrosis / Q000150:complications / Q000601:surgery*; D019651:Plastic Surgery Procedures / Q000379:methods*; D013524:Surgical Flaps; D058106:Wound Closure Techniques