Ten patients who underwent surgery for thoracic radiation ulcers were divided into recurrent and non-recurrent ulcer groups. We investigated clinical courses and complications, with a focus on ectopic calcification, aiming to identify features associated with recurrence. The recurrence rate of the seven patients treated at our department was 28.6%. Recurrence occurred in an atrophic area of the skin between the initial surgical site and the regional lymph nodes in all patients. Although regional lymph node irradiation was not examined in this study, we hypothesize that it causes osteonecrosis and sternoclavicular joint damage. Ectopic calcifications that continue to grow under atrophic skin near the sternoclavicular joint were associated with osteonecrosis and ulcer recurrence. Therefore, it is necessary to check patients' history of local lymph node irradiation, extend bone removal on the lymph node side, excise ectopic calcifications under atrophic skin, and cover the surgical wound with a thick flap.
