Management of chronic cervical radiodermatitis lesion using latissimus dorsi flap, report of a case

Abstract

Chronic radiodermatitis is a complication of radiotherapy that occurs several months or years after the end of treatment. The cervical region is the most affected. Surgery remains the treatment of choice, with sufficient excision and reconstruction using a variety of means, especially flaps, in particular the latissimus dorsi flap. This was a 60-year-old patient, chronic smoker, treated with radiotherapy for cavum cancer two years ago. He was admitted for chronic cervical radiodermatitis, evolving for nine months. Clinical examination revealed an ulcerative-bourgeoning lesion with at magnetic resonance imaging, a lesion extending to the subcutaneous plane and located in the irradiated area. Anatomopathological examination after excision-biopsy of the specimen revealed an ulcerated fibro-inflammatory remodelling of cicatricial appearance, without histological signs of malignancy. The residual loss of substance was treated by a musculocutaneous flap of the latissimus dorsi pedicled in a vascular island, with simple postoperative evolution. The pedicled latissimus dorsi flap is a reliable option for reconstruction of cervicofacial tissue defects due to tissue quality, reproducibility, and low donor site morbidity. It allows for effective management of neck radiodermatitis lesions, thus preventing malignant transformation. Radiodermatitis lesions in the cervical region can be a source of deterioration in patients' quality of life. The pedicled latissimus dorsi flap remains a favorable choice for locoregional reconstruction, despite the rise of free flaps.