Reconstruction of Osteoradionecrosis Defect of Chest Wall with Contralateral Pectoralis Major Myocutaneous Flap

A BSTRACT Osteoradionecrosis (ORN) of the chest wall is a rare and late complication which occurs in about 1%–7% of individuals undergoing radiation after breast cancer surgery. Management of the condition has to be customized according to the individual patient concerns as there are no established guidelines. Surgical debridement of the nonviable skin, soft tissue, cartilage and bone followed by coverage of the defect with well-vascularized muscle offers pain relief and wound cover. In this report, a case of ORN of the right chest wall which was managed successfully is presented. An elderly female came with complaints of chronic nonhealing wound in the right chest wall for the last 6 months. She had undergone oncological management (Surgery + Chemo and radiation) of the right breast cancer 14 years ago and since then had an uneventful life. She had developed blisters and watery discharge followed by skin breakdown and ulceration for the last 6 months. The diagnosis of ORN was confirmed with a biopsy of the lesion and computed tomography scan of the chest. After cardiac and anesthesia assessments were completed, she was taken for surgery under general anesthesia. Wide excision of the lesion was done followed by coverage of the defect by mobilization of the pectoralis major myocutaneous flap from the left side. Although contralateral and ipsilateral latissimus dorsi muscle use for chest wall reconstruction are reported in the literature, use of contralateral pectoralis major muscle is not yet reported and the authors infer that contralateral pectoralis major muscle and myocutaneous flaps offer an alternate option in addition to latissimus dorsi muscle or myocutaneous flaps in selected cases.