# Surgical release of the chest wall skin and fascia for sclerodermatous graft versus host disease causing restrictive lung disease: A case report

## TL;DR

A patient with severe skin GVHD causing lung issues had surgery to improve chest expansion and quality of life, with mixed long-term results.

## Contribution

This case report explores surgical release of chest wall skin and fascia as a treatment for sclerodermatous GVHD-related restrictive lung disease.

## Key findings

- Surgical release with split skin grafting improved the patient's lung function and quality of life subjectively.
- The patient requested a second surgical procedure, indicating perceived benefit.
- Despite initial improvement, lung function continued to decline over time.

## Abstract

Graft versus host disease (GVHD) remains a significant source of morbidity and mortality in the setting of allogeneic stem cell transplantation. Skin involvement is reported to be as high as 70–95 % in this group with GVHD and the severity of the involvement varies widely. Surgical management of complications of severe cutaneous GVHD is uncommon and is rarely mentioned as a treatment option.

We present a case of severe sclerodermatous skin changes restricting chest expansion and exercise tolerance to the point of limiting basic activities of daily life. A 54-year-old male presents with severe restrictive lung disease from sclerodermatous graft versus host disease (GVHD) after stem cell transplant for Chronic Myeloid Leukaemia (CML). He experienced limited symptomatic relief from maximal medical therapy and photochemotherapy, and subsequently underwent a skin release and split skin grafting of his chest and abdomen in an effort to improve exercise tolerance and quality of life.

Despite an initial improvement in functioning, the patient's spirometry and lung function continued to decline with time, possibly suggesting that he did not gain a sustained benefit from surgical release of his cutaneous GVHD.

While delineating between disease progression and surgical outcome is difficult in this case, the patient would argue that by delaying or reducing further decline in function, the surgical release procedures led to improved quality of life in subsequent years. However further research is required to establish a clear role for surgery in the treatment of refractory cutaneous GVHD.

•Surgical release with split skin grafting requires further evaluation to establish a clear role in the treatment of restrictive lung disease due to cutaneous GVHD•Skin release (Chest Escharotomy Pattern) in restrictive lung disease caused by graft vs Host disease, objectively and subjectively improved the patient’s lung function.•There were no adverse outcomes for the patient related to this surgical intervention, in fact the patient requested a second operative skin release and skin grafting.

Surgical release with split skin grafting requires further evaluation to establish a clear role in the treatment of restrictive lung disease due to cutaneous GVHD

Skin release (Chest Escharotomy Pattern) in restrictive lung disease caused by graft vs Host disease, objectively and subjectively improved the patient’s lung function.

There were no adverse outcomes for the patient related to this surgical intervention, in fact the patient requested a second operative skin release and skin grafting.