Management of Severe Skin Flap Necrosis after Mastectomy: Case Report

Yinglai Huang, Karin Jogeland, Marianne Samuelsson, Ann Hägerström, Evy Larsson
2018 Journal of surgery (Lisle, IL)  
Mastectomy skin flap necrosis occurs more frequently than perceived, and an overall incidence of 5%-30% of cases is reported in the literature. The optimal management of severe mastectomy skin flap necrosis continues to remain a challenge. Here, we report a case of unexpected severe skin necrosis after mastectomy in a patient with ductal invasive carcinoma classified as pT2, N0 M0. On the 7th postoperative day, the patient developed an extensive full-thickness flap necrosis on the breast. This
more » ... n the breast. This report presents such a case, in which the patient was successfully treated with modified rhomboid (Limberg) flap operative management and negative-pressure wound therapy. Methods: Patient photographs and wound measurement were used to estimate area of necrosis as about 50% for massive skin flap loss. The patient was managed initially with local wound care followed by delayed modified rhomboid (Limberg) flap operative management to close the skin defects. Postoperative Negative Pressure Wound Therapy (NPWT) with PICO (Smith & Nephew) system consisting of a single-use sterile pump and 2 multi-layered adhesive dressings. Results: Modified rhomboid (Limberg) flap operative management to close the skin flap defects followed by PICO negative pressure wound therapy produced excellent results in this patient with massive mastectomy skin flap loss. Conclusions: Mastectomy skin flap necrosis is a common complication and may present as massive mastectomy skin flap loss. To the best of our knowledge, use of modified rhomboid (Limberg) flap for closing of massive mastectomy skin flap defects has not been previously reported. The outcomes described in this report may help in the decision-making process for clinicians who are confront with this difficult problem.
doi:10.29011/2575-9760.001184 fatcat:xnpxc5vdujbvbedftndseulw2m