Reconstructive Management for Chest Wall Radiation-induced Ulcers Following Mastectomy

Patients who undergo radiotherapy following mastectomy may develop radiation-induced ulcers (RIUs) years later that are often refractory to healing. Reconstruction of these refractory ulcers remains a challenge for surgeons, and conventional surgical approaches can have disastrous outcomes.

We present a detailed itemization and analysis of specific surgical methods-including local random-pattern flaps, pedicled flaps, and free flaps-as well as conservative treatments, along with their therapeutic outcomes, advantages, and disadvantages.

Chest wall reconstruction is safe and feasible with low perioperative mortality. Regardless of whether local random-pattern flaps, pedicled flaps, or free flaps are used, the cornerstone of RIU management is the complete excision of the affected skin and bone, followed by permanent wound closure and chest wall reconstruction using skin or muscle flaps. This procedure necessitates careful patient selection, clear indication delineation, and appropriate choice of the most suitable reconstructive method.

Properly applied flap reconstruction can achieve healing in over 90% of RIUs, significantly improving the patient's quality of life.