title: Change of paradigm in thoracic radionecrosis management.
abstract: Classically, muscular or omental flaps are the gold standard in the management of thoracic defects following radionecrosis debridement. Their vascular supply and antibacterial property was supposed to enhance healing compared with cutaneous flaps. The evolution of reconstructive surgery allowed us to challenge this dogma. Therefore, we present five consecutive cases of thoracic radionecrosis reconstructed with cutaneous perforator flaps. In four patients, we performed a free deep inferior epigastric perforator (DIEP) flap and one patient had a thoracodorsal perforator (TDAP) flap. Median time healing was 22.6 days with satisfactory cutaneous covering and good aesthetic results. There were no flap necrosis, no donor site complications. We believe that perforator flaps are a new alternative, reliable and elegant option that questions the dogma of muscular flaps in the management of thoracic radionecrosis.
authors.affiliation: Department of Plastic, Reconstructive and Aesthetic surgery, Amiens Picardie University, place Victor-Pauchet, 80054 Amiens, France.
authors.forename: S
authors.initials: S
authors.lastname: Dast
authors.affiliation: Department of Plastic, Reconstructive and Aesthetic surgery, Amiens Picardie University, place Victor-Pauchet, 80054 Amiens, France.
authors.forename: N
authors.initials: N
authors.lastname: Assaf
authors.affiliation: Department of Plastic, Reconstructive and Aesthetic surgery, Amiens Picardie University, place Victor-Pauchet, 80054 Amiens, France.
authors.forename: L
authors.initials: L
authors.lastname: Dessena
authors.affiliation: Department of Plastic, Reconstructive and Aesthetic surgery, Amiens Picardie University, place Victor-Pauchet, 80054 Amiens, France.
authors.forename: H
authors.initials: H
authors.lastname: Almousawi
authors.affiliation: Department of Plastic, Reconstructive and Aesthetic surgery, Amiens Picardie University, place Victor-Pauchet, 80054 Amiens, France.
authors.forename: C
authors.initials: C
authors.lastname: Herlin
authors.affiliation: Department of Plastic, Reconstructive and Aesthetic surgery, Amiens Picardie University, place Victor-Pauchet, 80054 Amiens, France.
authors.forename: P
authors.initials: P
authors.lastname: Berna
authors.affiliation: Department of Plastic, Reconstructive and Aesthetic surgery, Amiens Picardie University, place Victor-Pauchet, 80054 Amiens, France. Electronic address: raphaelsinna@gmail.com.
authors.forename: R
authors.initials: R
authors.lastname: Sinna
mesh_terms: D000368:Aged; D001943:Breast Neoplasms / Q000532:radiotherapy; D005260:Female; D006801:Humans; D008875:Middle Aged; D009336:Necrosis / Q000601:surgery; D061525:Perforator Flap; D011855:Radiodermatitis / Q000601:surgery*; D012867:Skin / Q000473:pathology*; D014945:Wound Healing
keywords: Chest wall; Lambeau perforant; Paroi thoracique; Perforator flap; Radionecrosis; Radionécrose; Reconstruction