title: A difficult case: omental transposition flap reconstruction of a large radionecrotic axillary ulcer in a patient with extensive previous abdominal surgery.
abstract: Radionecrotic ulcers due to breast cancer treatment is a highly morbid and disabling condition, causing pain, malodour, need for frequent dressings, reduced range of shoulder movements and an unacceptable cosmetic appearance. In patients with radiotherapy to the chest and/or axilla and general poor health the usual reconstructive options may not be suitable due to regional tissue damage and inappropriate long anaesthetic time, respectively. Described procedures include the pedicled latisimus dorsi flap, transverse rectus abdominal flap (TRAM) and omental transposition flap, as well as free tissue transfer (e.g. free TRAM, DIEP). We report a case of a morbidly obese female patient presenting with a large radionecrotic ulcer in her left axilla, following mastectomy, axillary clearance and local radiotherapy to left chest and axilla for breast cancer. She underwent reconstruction using an omental transposition flap, despite previous abdominal surgery.
authors.affiliation: Department of Plastic Surgery, Royal Free Hampstead NHS Trust, Pond Street, London NW3 2QG, UK. ceahartmann@gmail.com
authors.forename: Christoph E A
authors.initials: CE
authors.lastname: Hartmann
authors.forename: Loretta W L
authors.initials: LW
authors.lastname: Ko
authors.forename: Lucion
authors.initials: L
authors.lastname: Ion
authors.forename: Barbara
authors.initials: B
authors.lastname: Jemec
mesh_terms: D001365:Axilla / Q000528:radiation effects / Q000601:surgery; D001943:Breast Neoplasms / Q000473:pathology / Q000532:radiotherapy / Q000601:surgery; D018270:Carcinoma, Ductal, Breast / Q000473:pathology / Q000532:radiotherapy / Q000601:surgery; D005260:Female; D006801:Humans; D016462:Mammaplasty / Q000379:methods; D008408:Mastectomy / Q000379:methods; D008875:Middle Aged; D009361:Neoplasm Invasiveness / Q000473:pathology; D009367:Neoplasm Staging; D009767:Obesity, Morbid; D009852:Omentum / Q000601:surgery / Q000637:transplantation*; D011832:Radiation Injuries / Q000503:physiopathology / Q000601:surgery*; D011855:Radiodermatitis / Q000601:surgery; D018714:Radiotherapy, Adjuvant / Q000009:adverse effects; D017568:Rectus Abdominis / Q000601:surgery; D018570:Risk Assessment; D012720:Severity of Illness Index; D012883:Skin Ulcer / Q000209:etiology / Q000601:surgery*; D013524:Surgical Flaps; D016896:Treatment Outcome; D014945:Wound Healing / Q000502:physiology