296 Knowing When to Put the Knife Down - a Case Report on Osteoradionecrosis of the Chest Wall

Abstract

Abstract Radiation therapy is a common treatment for carcinoma of the breast. It has shown to reduce the incidence of local reoccurrence and improve life expectancy, but it is not without complications. Osteoradionecrosis (ORN) of the chest wall is a recognised but rare complication, which can lead to full thickness necrosis, localised infection, and pathological rib fractures. This case report discusses a 78-year-old female with a history of adjuvant radiotherapy for a left breast malignancy, who developed three distinct wounds on her left anterior chest wall. Over five years, these wounds ulcerated and formed sinus tracks exposing the rib cage. The patient also developed various local infections requiring antibiotics. Management options were explored, ranging from conservative dressings, anti-inflammatories and steroids to medical options traditionally used to treat ORN of the mandible, such as the combination of Pentoxifylline and vitamin E, and Hyperbaric Oxygen Therapy (HBO2). However, the most beneficial definitive treatment proposed was surgical intervention using either a latissimus dorsi or an upper limb fillet flap. Despite this, the patient's social, cosmetic, and surgical concerns focussed the current management towards the conservative highlighting the importance of “putting down the knife” and the role of monitoring the disease with biannual clinic follow ups. While surgery is likely a necessity in the future, this case study highlights the importance of considering medical input and keeping the patient's interests at the forefront of surgical practice.