Infections and radiation injuries involving the chest wall

Soft tissue necrosis secondary to infection and radiation injury account for the majority of chest wall resections performed today that are unrelated to malignancy. Principles of treatment for chest wall infection and necrosis rely partially on the underlying cause and overall health of the patient but, in general, are based on wide resection of devitalized tissue and subsequent reconstruction with soft tissue coverage. Unlike resection for malignancy, fibrosis of underlying tissues often precludes skeletal reconstruction without concurrent loss of chest wall integrity or pulmonary function. Although the surgical intervention of these processes is similar, the underlying pathology differs significantly. This article addresses the risk factors, pathophysiology, clinical presentation, and management of chest wall and sternoclavicular joint infections, necrotizing processes, and radiation injury.