Introduction : Chronic ulceration on the chest wall is one of the long-term side effects following radiation therapy for breastcancer.It can occur even after several decades have passed since the initial radiation treatment and often accompanies osteomyelitis of ribs and/or sternum.The condition is slowly progressive and recalcitrant and surgical intervention including debridement and reconstructive surgery is definitely inevitable to achieve a cure.Through the review of the cases that had been treated in our department, here we affirm the therapeutic principle of radiation-induced ulcer on the chest wall.Method:After the database search, 12 cases (mean age 70.8± 8.5 yrs) were included in this retrospective study and their medical records were reviewed.Results and discussion:The period between the radiation therapy for breast cancer and the surgical treatment for the chronic ulcer was 30.2± 8.0 yrs.Except for one case who refused massive surgery and was treated with local cutaneous flap, extensive debridement including irritated skin and infected osteocartilageous tissue was performed before flap coverage.Debridement extended over more than two (maximum five) ribs and/or sternum in these 11 cases.Although thoracic reconstruction with autologous or artificial firm material was not performed, none of the cases encountered paradoxical breathing related problem.Flap coverage was performed with VRAM flap in six, LD flap in three, PM flap in two, and local flap in one.Additional debridement required in two cases and only three cases cure without any problem.For the treatment of radiation-induced ulcer on the chest, excessive debridement of skin and osteocartilaginous tissues and coverage with plentifully-sized, well-vascularized flap should be primary concerned.