LD Flap For Chemoport Complication

Brief History :

72-year-old lady with multiple comorbids was treated outside for a T2N0 Triple-negative breast cancer. She had undergone mastectomy along with Chemoport insertion 6 years back. She had also received chemotherapy after surgery. At the outset, she had extravasation of chemotherapy drugs at the port site during the second chemotherapy cycle. This manifested as a swelling for which the port was removed. Over a period of 6 years, the swelling increased in size and discharging sinuses developed with chronic pain. She presented to us with a 7 × 7 cm mobile swelling in the infraclavicular region extending to root of neck superiorly and medially upto mid clavicle (Fig. 1). CT scan displayed chest wall mass 6.2 × 2.2 × 8 cm sitting over pectoralis major with lot of calcification and no evidence of recurrence.

Fig 01. Showing the chemoport site with discharging sinuses and calcifications.
Fig 01. Showing the chemoport site with discharging sinuses and calcifications.

Patient concerns:

Because of the persistent pain and discharge from the wound, the patient was severely distressed. She wanted to know if it was possible to get rid of the problem. However she was worried about undergoing surgery.

Treatment offered:

Since the Chemoport site was infected with multiple sinuses and had significant calcification this could not have been managed conservatively. Hence she was advised to undergo excision of the lesion along with flap reconstruction of the defect.

Results:

She underwent resection of the swelling with a pedicled latissimus dorsi flap reconstruction (Figs. 2 and 3). She recovered well post operatively.

Fig 02. Post operative picture showing LD flap covering the excised portion of the skin.
Fig 02. Post operative picture showing LD flap covering the excised portion of the skin.
Fig 03. Donor area at the back
Fig 03. Donor area at the back

Core message:

Though this patient did not have recurrence of the cancer and was essentially cured of it, she was still suffering from the adverse effect of one of the cancer treatments. This affected her quality of life significantly and thus took away the benefits of a successful treatment.The treatment offered to her cured her problem. She could get back to her daily life without any pain, without any dressing and without any worry.

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