Objective To evaluate a repair approach to major defects of chest wall caused by recurrent lesion or radiation ulcer after radical mastectomy.Methods The delto-pectoral island flaps were applied to repair major defects of chest wall.The blood supply of the flap was from the 2nd and 3rd anterior perforator of the internal mammary artery.4 patients with defects of chest wall caused by recurrent cancer lesion and 8 patients caused by radiation ulcer received the pedicled flap after resection of lesion or ulcer.Results All the 12 flaps survived,in which flap necrosis at the distal end occurred in 1 case and it was cured after changing dress.After a follow-up of 6 monthls to 4 years,the flap healed and the cosmetic effect was satisfactory.Conclusions This method is an ideal method for repair of stage I major defects of chest wall caused by recurrent lesion and radiation ulcer after radical mastectomy.