Thoracodorsal Artery Perforator Flap for Chronic Radiation-Induced Ulcer Grade 4: A Case Series Report

Background: Radiotherapy takes an important role in the management of breast cancer. Therefore, radiation-induced skin ulcer caused by the acute or chronic effects of ionizing radiation might be another challenge. The treatment of chronic radiation-induced ulcers is further complicated because they are often combined with other radiation side effects.

Case Presentation: We report two cases of women suffering from breast cancer. These patients had mastectomy surgery 7 and 10 years ago followed with 70 gy external beam radiation therapy using cobalt 66. The first patient had a chronic expanded ulcer in the last 2 years with a diameter of 10 x 4cm now. In the second patient, the ulcers formed as a hole under the armpit in the past 1 year with a size of 3 x 2cm. Both patients’ ulcers were odorless, pale in color on surrounding tissue with no sign of granulation and no pus. After a long period of treatment with no results, we decided to use a thin layer flap rich in vascularization for both cases. The flap chosen was the thoracodorsal artery perforator flap. From both cases, follow-up postoperative showed good results in coverage, cosmetic, and functional aspects. The flap perforator succeeds in creating less bulky coverage, free range of motion, no infection, flap loss, and necrosis at the site.

Conclusion: Thoracodorsal artery perforator flap is a safe option for the reconstruction of skin ulcer caused by radiation. This technique has the advantage of reducing donor site morbidities.