title: Multi-staged flap reconstruction for complex radiation thoracic ulcer.
abstract: BACKGROUND
  Chest wall reconstruction due to previous radiation therapy can be challenging and complex, requiring a multidisciplinary approach.
  
  
  METHODS
  The authors present the case of a 84-year-old woman with a right chest wall radionecrosis ulcer, that was submitted to an ablative surgery resulting in a full-thickness defect of 224cm(2), firstly reconstructed with a pedicled omental flap. Due to partial flap necrosis, other debridements and chest wall multi-staged flap reconstruction were performed.
  
  
  CONCLUSIONS
  This case highlights that the reconstructive choice should be individualized and dependent on patient and local factors. The authors advise that surgical team should work closely and be well versed in chest wall reconstruction with a variety of pedicled flaps, when a complication occurs.
  
  
  CONCLUSIONS
  A multi-staged flap reconstruction could be a salvage procedure for the coverage of complex, great and complicated chest wall defects due to previous radiation therapy.
authors.affiliation: Department of Plastic, Reconstructive and Aesthetic Surgery, Maxillofacial Surgery, and Burn Unit, Centro Hospitalar de São João, Porto University Medical School, Porto, Portugal. Electronic address: ritavf@sapo.pt.
authors.forename: Rita
authors.initials: R
authors.lastname: Valença-Filipe
authors.affiliation: Department of Plastic, Reconstructive and Aesthetic Surgery, Maxillofacial Surgery, and Burn Unit, Centro Hospitalar de São João, Porto University Medical School, Porto, Portugal.
authors.forename: Ricardo
authors.initials: R
authors.lastname: Horta
authors.affiliation: Department of Plastic, Reconstructive and Aesthetic Surgery, Maxillofacial Surgery, and Burn Unit, Centro Hospitalar de São João, Porto University Medical School, Porto, Portugal.
authors.forename: Joana
authors.initials: J
authors.lastname: Costa
authors.affiliation: Department of Plastic, Reconstructive and Aesthetic Surgery, Maxillofacial Surgery, and Burn Unit, Centro Hospitalar de São João, Porto University Medical School, Porto, Portugal.
authors.forename: Jorge
authors.initials: J
authors.lastname: Carvalho
authors.affiliation: Department of Plastic, Reconstructive and Aesthetic Surgery, Maxillofacial Surgery, and Burn Unit, Centro Hospitalar de São João, Porto University Medical School, Porto, Portugal.
authors.forename: Apolino
authors.initials: A
authors.lastname: Martins
authors.affiliation: Department of Plastic, Reconstructive and Aesthetic Surgery, Maxillofacial Surgery, and Burn Unit, Centro Hospitalar de São João, Porto University Medical School, Porto, Portugal.
authors.forename: Álvaro
authors.initials: Á
authors.lastname: Silva
keywords: Chest wall; Flap; Radiation therapy; Radionecrosis; Thoracic ulcer