Latissimus dorsi flap reconstruction of axillary defect caused by excision of ulcerated and infected mass ten years after mastectomy: a case report

Breast cancer recurrence poses a significant clinical challenge, even with improvements in surgical and adjuvant therapies. Local and regional recurrences may develop several years after the initial treatment and require extensive resection and subsequent reconstruction. The axillary area further complicates the situation because of its complex anatomy and the necessity to maintain shoulder mobility. Among available reconstructive options, the LD flap remains one of the most reliable reconstructive techniques, offering a large, well-vascularized tissue with a predictable blood supply and a wide arc of rotation. A 63-year-old woman with a body mass index of 35 and no chronic comorbidities presented to our hospital with a foul-smelling, ulcerated mass in the left axilla that developed ten years after undergoing a left modified radical mastectomy with axillary dissection, followed by adjuvant chemotherapy and radiotherapy. Preoperative contrast CT of the chest showed multiple left axillary lymph nodes, which were matted with the largest one being 6.6 × 3.7 cm, along with a destructive sternal lesion, but no major vessel involvement. Surgical debridement and excision of the ulcerated mass were performed, followed by immediate reconstruction using an LD flap. The postoperative course was uneventful at first, with the flap maintaining viability. At the seven-month follow-up visit, the wound had completely healed without evidence of recurrence, and the patient demonstrated good shoulder mobility, with only a slight restriction in abduction and a hypertrophic scar at the donor site. Re-irradiation and adjunctive treatments were not indicated in this case due to the palliative intent of surgery. This case illustrates the successful utilization of the latissimus dorsi flap for reconstructing complex axillary defects, especially in areas that have been previously radiated and infected. The flap provided good blood supply and yielded satisfactory functional and cosmetic results. The careful choice of flap, along with the teamwork of specialists in the management of the patient, is vital for the optimal results in the reconstruction of recurrent breast cancer.