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Management of Osteoradionecrosis of the Anterior Thoracic Wall Using Omental Flaps: a Prospective Case Series and Literature Review

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Abstract

Rib-sternal osteoradionecrosis is a rare but serious complication of chest radiotherapy. No consensus-based method of managing deep sternal wounds that develop after radiotherapy is available. Usually patients require long-term antibiotics. The surgical placement of a muscle, an omental flap, or a prosthesis is described. We report, in pictures, four successful omental flap placements. Between March 2015 and July 2018, four women with deep sternal wound injuries that developed after radiation therapy to treat breast cancer underwent rib-sternal reconstruction with omental flap placement. The first signs of infected radionecrosis developed 28.5 years after radiotherapy. Despite prolonged antibiotic treatment, surgery was necessary. The mean age at surgery was 76 years (range: 62–86 years). All necrotic tissue was excised and debridement was performed before the placement of a pedicled omental flap dissected along the transverse colon and raised through a subcutaneous tunnel. No skin graft or osteosynthesis was required. After surgery, lubricated bandages were applied daily, and antibiotics were prescribed for a few weeks. Complete healing was obtained after surgery without clinical complication. Our experience suggests that a pedicled omental flap is an affordable, simple, and very useful option for reconstructing deep rib-sternal wounds caused by radiation.

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Authors and Affiliations

  1. Thoracic Surgery Department, Bordeaux University Hospital and Bordeaux University, avenue de Magellan, 33604, Pessac, France

    Yaniss Belaroussi, Romain Hustache-castaing, Jacques Jougon & Matthieu Thumerel

  2. Plastic and Reconstructive Surgery Department, Bordeaux University Hospital and Bordeaux University, place Amélie Raba Leon, 33000, Bordeaux, France

    Vincent Casoli

  3. Service de Chirurgie Thoracique, CHU Bordeaux, Université de Bordeaux, Avenue Magellan, 33604, Pessac, France

    Matthieu Thumerel

Authors
  1. Yaniss Belaroussi
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  2. Romain Hustache-castaing
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  3. Jacques Jougon
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  4. Vincent Casoli
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  5. Matthieu Thumerel
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Correspondence to Matthieu Thumerel.

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This is an observational study. The Research Ethics Committee has confirmed that no ethical approval is required.

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Belaroussi, Y., Hustache-castaing, R., Jougon, J. et al. Management of Osteoradionecrosis of the Anterior Thoracic Wall Using Omental Flaps: a Prospective Case Series and Literature Review. Indian J Surg 84, 110–116 (2022). https://doi.org/10.1007/s12262-021-02835-w

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  • DOI: https://doi.org/10.1007/s12262-021-02835-w

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