[Plastic reconstruction of the irradiated thoracic wall]

Chest-wall reconstruction following irradiation requires a surgical approach that addresses the specific healing disorders associated with irradiation: (1) biopsy of any open wound to rule out recurrence or persistence of tumor; (2) aggressive debridement of all necrotic or infected tissue, especially osteonecrosis of the chest wall; (3) reconstruction with well-vascularized muscle or musculocutaneous flaps. Coverage with muscle flaps provides a very reliable and effective single-stage reconstruction. Most types of flaps employed involve the latissimus, rectus abdominis and pectoralis muscle or musculocutaneous flaps. Rarely, stabilization of the thoracic wall is required, mostly facilitated by nonresorbable mesh. Respecting these principles, the irradiated chest wall can be reconstructed safely and with low morbidity. Plastic reconstructive techniques may also be employed safely to reconstruct the breast simultaneously in irradiated tissue by use of latissimus or rectus abdominis flaps.