The Breast Journal | 2019
Unusual burn injury to a deep inferior epigastric perforator flap reconstructed breast
Abstract
A 64-year-old woman with right-sided breast cancer was treated using modified radical mastectomy and adjuvant chemotherapy, followed by radiotherapy and hormonal therapy. In May 2016, she underwent delayed breast reconstruction by free deep inferior epigastric perforator (DIEP) flap, followed by nipple-areola complex reconstruction without contralateral breast symmetrisation at her request. Two years later, she presented with a lesion in the center of the cutaneous paddle of the reconstructed breast that initially appeared to be a blister progressing toward an insensitive ulceration (size 6 cm × 2 cm). Initially, the lesion was managed conservatively by her family doctor. Two weeks later, she was referred to her surgeon; she had a clearly defined well-circumscribed eschar over the flap (Figure 1). Treatment of this deep second-degree burn consisted of local care, debridement using a hydrogel, and re-epithelization with a hydrocellular dressing. Her clinical outcome was favorable, with a dyschromic scar as the only sequelae. It was difficult for the patient to identify the exact circumstances of the burn because she had not felt it immediately. According to her, the burn was caused by prolonged contact with a hot cup of tea that was rested on her clothed chest. Our patient was completely satisfied with the natural aesthetic result of her breast reconstruction. The goals of breast reconstruction were considered to be achieved, as it allows the patient to live and dress “as before”. The danger comes when the patient forgets that she has a reconstructed breast that requires specific precautions. The quality and level of spontaneous sensory recovery is variable for non-neurotized DIEP flaps and ranges from little or no sensation to satisfactory or nearly normal sensation in the years following surgery. As the cutaneous paddle of the free flap does not play its role in sensory protection and thermoregulation, this can make patients susceptible to burns in ordinary everyday situations, such as exposure to heating pads, steam, or hot water and even sun exposure while wearing dark clothes. This clinical case illustrates how vulnerability to thermal injury in the short and long term is a danger in the everyday life of patients with breast reconstruction. Surgeon and patient awareness regarding this rare complication is essential for preventing it.