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首页> 外文期刊>BMC Surgery >Radiation-induced thoracic necrosis with a pulmonary cutaneous fistula repaired using a free omental flap: a case report
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Radiation-induced thoracic necrosis with a pulmonary cutaneous fistula repaired using a free omental flap: a case report

机译：放射性胸膜坏死合并游离网膜皮瓣修复的肺皮肤瘘管：一例

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Chest wall necrosis can manifest as a late effect of radiation therapy for breast cancer. Only two cases of fistulas communicating with the respiratory tract as a result of radiation-induced necrosis of the lungs or bronchi have been reported. To the best of our knowledge, we report the first case of a pulmonary cutaneous fistula arising as a late effect of radiation therapy for breast cancer, which was successfully repaired using a free omental graft. A 64-year-old woman underwent Halsted surgery and postoperative radiation therapy for breast cancer 25?years earlier. One year before visiting our hospital, she developed a fistula and bleeding in her left clavicular region, which was expanding. On initial examination, a 6-cm-wide skin defect was observed in the left clavicular region and the clavicle appeared sequestrated. Computed tomography revealed part of the first to third left ribs, part of the left clavicle, the subclavian artery, and the brachial plexus to be missing. Several rounds of debridement revealed approximately 10 bronchial stumps on the surface of the collapsed lung, from which exhaled air and sputum were effusing. Surgery was performed to implant a free omental flap with vascular anastomosis and a skin graft in the neck region, and the pulmonary cutaneous fistula was closed. Two years after surgery, emphysema remained inside the omentum, which spontaneously resolved by the 3rd postoperative year. Various treatment options are conceivable for the repair of pulmonary cutaneous and bronchocutaneous fistulas induced by radiation damage (e.g., free tissue grafts and endoscopic bronchial occlusion); however, these are rarely reported, and the most reliable method thus remains unclear. Positive outcomes in our case indicate that implanting a free omental graft may be effective. Furthermore, spontaneous healing can be expected for the residual emphysema inside the omentum.
机译：胸壁坏死可表现为放射治疗对乳腺癌的晚期作用。据报道，只有两例由于辐射引起的肺或支气管坏死而使瘘管与呼吸道连通的病例。据我们所知，我们报道了第一例因放射疗法对乳腺癌的晚期治疗而产生的肺部皮肤瘘，该病例已通过游离网膜移植物成功修复。一名64岁的女性在25年前接受了Halsted手术并接受了乳腺癌的术后放射治疗。到我们医院就诊的前一年，她的左锁骨区域出现了瘘管和出血，并在扩大。最初检查时，在左锁骨区域观察到6厘米宽的皮肤缺损，锁骨被隔离。计算机断层扫描显示第一至第三肋骨的一部分，左锁骨，锁骨下动脉和臂丛神经的一部分缺失。几轮清创术显示，在塌陷的肺表面约有10个支气管残端，呼出的空气和痰从中排出。进行手术以在颈部区域植入具有血管吻合的游离网膜皮瓣和皮肤移植物，并封闭肺部皮肤瘘。手术后两年，气肿仍留在大网膜内，并在术后第三年自发消退。可以设想多种治疗方案，以修复由放射损伤引起的肺部皮肤和支气管皮肤瘘（例如，游离组织移植物和内窥镜支气管闭塞）;然而，这些很少被报道，因此最可靠的方法仍然不清楚。在我们的案例中，积极的结果表明植入免费的网膜移植物可能是有效的。此外，网膜内残留的肺气肿可预期自发愈合。

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