Key Points

• Infection or radionecrosis accounts for about 20% of chest wall resections and reconstructions.
• Careful preoperative planning with a plastic surgeon is critical.
• All irradiated and infected tissue are removed.
• Reconstruction with muscle or myocutaneous flaps yields good results.

Radionecrosis and infection of the chest wall are relatively uncommon problems, yet they are difficult to manage without experience. These lesions usually occur in patients that are debilitated and immunosuppressed from a protracted illness. Radionecrosis is an iatrogenic illness. This chapter describes the pathophysiology of radiation necrosis and chest wall infections and explains the management of this difficult problem.