Surgical treatment with sternal and rib resection for patients with post-irradiation ulcer of the chest wall

Postoperative radiotherapy is widely performed in the treatment of patients with lymph node metastases from carcinoma of the breast, however, depending on the dose, cases are seen in which radiation ulcers develop and require surgical management. In the present paper we report a patient in whom postoperative radiotherapy was performed because parasternal lymph node metastasis was discovered at the time of surgery and who 15 months later experienced thoracic wall recurrence. Since metastasis to the contralateral lung was observed at that time, reoperation was not attempted, and when radiotherapy was again administered, an extensive radiation ulcer developed in association with sternal and costal necrosis. The skin and subcutaneous tissue together with the sternum and ribs were widely resected followed by the thoracoplasty using a latissimus dorsi musculocutaneous flap. Since there was no postoperative infection, the skin flap was accepted well, and the outcome was satisfactory from the standpoint of quality of life, we have reported the case. (author)