Background: Radiation ulcers after percutaneous coronary intervention (PCI) have recently become common. However, its diagnosis, treatment, and prevention strategies have not been well studied.
Objectives: To present our experiences in diagnosis, treatment, and prevention of PCI-related radiation ulcers
Methods: Patients diagnosed with PCI-related radiation ulcers were collected. Radiation fields of PCI were simulated using the Pinnacle treatment planning system to confirm the diagnosis. Surgical methods and outcomes were reviewed, and a prevention protocol was introduced and evaluated for its effectiveness.
Results: Seven male patients with ten ulcers were included. Among the patients, the right coronary artery was the most common target vessel of PCI, and the left anterior oblique was the most commonly used PCI view. Nine ulcers had undergone radical debridement and reconstruction: four smaller ones by primary closure or local flaps and five by thoracodorsal artery perforator flaps. No new cases were identified in a 3-year interval after conducting the prevention protocol.
Conclusion: PCI-related ulcer diagnosis is more evident with radiation field simulation. The thoracodorsal artery perforator flap is an ideal option for back or upper arm radiation ulcer reconstructions. The prevention protocol of PCI procedure is effective to lower the incidence of radiation ulcers.

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