Delayed Presentation of Radiation Induced Rib Bone Necrosis after Mastectomy Radiation Induced Rib Bone Necrosis

J Korean Wound Management Soc > Volume 12(2); 2016 > Article

Clinical Report

Journal of the Korean Wound Management Society 2016;12(2): 61-64.

Delayed Presentation of Radiation Induced Rib Bone Necrosis after Mastectomy Radiation Induced Rib Bone Necrosis

Yoon Jae Lee, SeongYeon Kim, Deuk Young Oh

Department of Plastic and Reconstructive Surgery, College of Medicine, The Catholic University of Korea, Seoul, Korea

Published online: 30 November 2016.

ABSTRACT

Radiotherapy is mandatory for breast cancer treatment. Unfortunately, the high-energy radiation used can lead to severe skin necrosis or ulceration. A 72 year-old woman presented with a palm size chronic skin lesion on right side of anterior chest wall which first appeared 6 months ago. The patient had no trauma history but had a history of receiving adjuvant postoperative radiotherapy about 25 years ago because of breast cancer after modified radical mastectomy. About 12×8 cm skin ulceration showed deep multiple punched out lesion with bone exposure. Radical debridement of all the necrotic tissue was performed including ostectomy of calcified necrotic rib bone. Pedicled latissimus dorsi musculocutaneous flap was used to cover the defect area. During long term follow-up, there was no sign of infection nor recurrence of skin lesion. The pathology of the debrided rib bone confirmed as osteomyelitis. Radiation induced necrosis is a chronic intractable wound that may threatens the patient’s life quality due to massive infection and sepsis. Radiation induced osteonecrosis occur mostly within 5 years after treatment but according to our case, it can also be encountered after 25 years following radiotherapy. (J Korean Wound Management Soc 2016;12:61-64)

Key Words: Radiation, Osteomyelitis, Breast neoplasm