Forearm fillet flap for defect closure after chest wall resection in a breast cancer patient after forequarter amputation

Abstract

BACKGROUND: Widespread local recurrence of breast cancer and extension to the chest wall and other nearby structures in patients after radio- and chemotherapy is not rare. Recurrence might be associated with ulceration and severe pain after radiation therapy. Paralysis of the arm might result from compression of the brachial plexus. METHODS: We report here on a breast cancer patient in whom chest wall resection to deal with tumor invasion was followed by reconstruction undertaken with a flap raised from the forearm of the amputated upper extremity which had been paralysed by tumor extension. RESULTS: The patient was reintegrated into family life, thus saving her from social isolation and psychological suffering caused by her stinking ulcer. In addition, her extreme physical suffering was ameliorated to a great degree despite accompanying mutilation. CONCLUSIONS: Palliative forequarter amputation, chest wall resection, and subsequent chest wall reconstruction might be considered in patients without detectable metastases for improving the patient’s quality of life, even though it may not be curative and chances of long-term survival may be poor. The patient, however, must find the price of severe mutilation acceptable.