Latissimus Dorsi Flap for Radiation-induced Chest Wall Ulcers

An 82-year-old female patient had a history of left breast carcinoma treated 15 years earlier with mastectomy followed by adjuvant radiotherapy. Fourteen years after the initial surgery, approximately 1 year before hospital admission, she developed a nonhealing ulcer over the left anterior chest wall at the site of prior irradiation. The patient has a history of hypertension, kidney failure, and malnutrition. The patient underwent biopsy, which excluded recurrent malignancy, and subsequently received outpatient wound care. Despite more than 8 months of wound management, the lesion progressively enlarged and eventually exposed the fifth rib. The patient underwent multidisciplinary consultation, and a decision was made to optimize general condition, manage underlying medical comorbidities, and perform wide excision of fibrotic and indurated tissue, followed by reconstruction of the defect using a pedicled latissimus dorsi musculocutaneous flap. The wound healed within 2 weeks. At the 5-month follow-up, the wound demonstrated satisfactory healing with no complications observed. This case suggests that radiation-induced wounds are classified as chronic nonhealing wounds, primarily due to radiation-associated fibrosis and compromised vascularity within the irradiated field. Definitive management requires wide excision of fibrotic, poorly perfused tissue, followed by reconstruction with well-vascularized tissue. In our case, persistence of ulceration for more than 8 months was excessively prolonged. Early multidisciplinary collaboration (including oncology, plastic and reconstructive surgery, and wound care specialists) would have facilitated earlier surgical intervention.