Thoracodorsal Artery Perforator Flap in the Treatment of Radiation Ulcers Related to Percutaneous Coronary Intervention

Introduction:

Chronic radiation ulcers that develop after percutaneous coronary intervention (PCI) are have become common recently because of the rapid increase in the use of diagnostic and interventional cardiac catheterization procedures. Most of the lesions are located on the back or upper arm. These ulcers are usually deep and refractory to conventional wound care. Standard treatments should consist of complete resection of all nonviable irradiated tissue and reconstruction with a well-vascularized, non-irradiated soft tissue flap. Thoracodorsal artery perforator (TDAP) flap is a reliable and easily dissected flap which should be an ideal choice of reconstruction of PCI related radiation ulcers.

Methods:

Between May 2016 and July 2017, we treated 4 patients with PCI related radiation ulcers. All the patients were male and their mean age was 58.75 (44-72) years old. They all had complex and prolonged PCI procedure prior to the ulcer occurrence. The mean interval between PCI and ulcer was 4.6 (0.5-14) months. All the patients underwent radical excision and were reconstructed with TDAP flap.

Results:

Among these 4 patients, three patients had right upper back lesions and one had right posteriolateral arm lesion. The average defect size after excision was 87.3 (45-130) cm². Two TDAP flaps were V-Y advanced flaps, one was a transposition flap and one was a pedicled island flap. All the flaps were totally survival, and the wounds were healed uneventfully.  

Conclusion:

For radiation ulcers related to PCI, complete resection and immediate reconstruction with flaps can improve the symptoms. TDAP flap can achieve reliable wound coverage with minimal complications and is an ideal solution for surgical reconstruction of back or upper arm radiation ulcers.