A 57-year-old patient came from another Service to assess the sequels of radiotherapy received in the neck as an adjunctive treatment of an epidermoid tumor of the larynx, for which seven years earlier.
On examination, the patient presented a radiodermitis affecting the entire anterolateral surface of the neck, but the changes became deeper on both lateral surfaces, showing an ulcerated area on the right side.
The patient reported pain in the radiated area with dysesthesia and hypersensitivity.
Initial treatment consisted of resection of the ulcerated area and surrounding skin.
The defect created on the right lateral surface of the neck was 7 x 8 cm, without exposure of vessels.
For its reconstruction a deltopectoral flap was raised, being the medial limit the exit of the perforating arteries of the internal mammary, the upper limit passed through the upper edge of the lateral clavicle reaching the lower intercostal space cm.
He didn't die and was tunneled until the defect.
Preoperatively, the exit of the perforating arteries of the internal mammary artery in the first three intercostal spaces was located by doppler.
The patient was discharged after 24 hours, with satisfactory results.
Four years later, the patient presented with a new ulceration affecting the contralateral surface of the neck, so the ulcer and the radiated tissue were resected. The second flap was performed using an 8 x 8 cm rectal biopsy.
The surgical time was one hour in each intervention.
The result was satisfactory, requiring skin graft donor site on both occasions.
After 8 years of evolution since the last intervention, the patient remains without complications, with dysesthesias.
