RECONSTRUCTION OF SEVERELY INFECTED GLUTEAL OSTEORADIONECROSIS USING NEGATIVE-PRESSURE WOUND THERAPY AND LATISSIMUS DORSI MUSCULOCUTANEOUS FLAPS

Abstract

Radiotherapy is mandatory for aggressive cancer treatment. Unfortunately, the high-energy radiation used can lead to severe osteoradionecrosis. Radical debridement of devitalized bone and soft tissue coupled with reconstruction using well-vascularized tissues is the accepted treatment for this condition. However, osteoradionecrosis cannot be controlled easily or rapidly. The aim of this study was to present the results of the use of serial negative-pressure wound therapy (NPWT) in combination with a latissimus dorsi myocutaneous flap for treatment of gluteal osteoradionecrosis in a consecutive series of patients. Between January 2003 and December 2012, nine patients underwent reconstruction using serial NPWT and latissimus dorsi myocutaneous flaps. We applied negative-pressure dressings for at least 8 weeks. Final reconstruction was performed after the infection was controlled. The superior gluteal artery and vein were used as recipient vessels in all the cases. The mean interval between operation and radiation therapy was 28.3 +/- 8.3 years, and the mean number of debridement performed was 6.3 +/- 1. NPWT dressings were applied for 8-12 weeks (mean, 9.3 +/- 2 weeks). The defects ranged in size from 14 x 8 cm to 18 x 15 cm. The flap size ranged from 15 x 10 cm to 18 x 15 cm. All flaps survived uneventfully except in one patient who experienced chronic seroma and wound dehiscence. There were no recurrences of osteomyelitis during the follow-up periods (mean, 14 +/- 6.1 months). Based on the results obtained from this consecutive series of patients, we suggest that this methodology may provide an alternative approach for the treatment of severe osteoradionecrosis of the gluteal region.