Fujioka M
Advances in wound care. Date of publication 2014 Jan 1;volume 3(1):25-37.
1. Adv Wound Care (New Rochelle). 2014 Jan 1;3(1):25-37.
Surgical Reconstruction of Radiation Injuries.
Fujioka M(1).
Author information:
(1)Department of Plastic and Reconstructive Surgery, Nagasaki University ,
Nagasaki, Japan . ; Department of Plastic and Reconstructive Surgery, Clinical
Research Center, National Hospital Organization Nagasaki Medical Center , Ohmura,
Japan .
Significance: Patients with cancer receive benefits from radiation therapy;
however, it may have adverse effects on normal tissue such as causing
radiation-induced ulcer and osteoradionecrosis. The most reliable method to treat
a radiation ulcer is wide excision of the affected tissue, followed by coverage
with well-vascularized tissue. As usual, radiation-induced skin ulcers are due to
therapeutic irradiation for residual cancer or lymph nodes; the locations of
radiation ulcers are relatively limited, including the head, neck, chest wall,
lumbar, groin, and sacral areas. Thus, suitable reconstructive methods vary
according to functional and aesthetic conditions. I reviewed the practices and
surgical results for radiation ulcers over the past 30 years, and present the
recommended surgical methods for these hard-to-heal ulcers. Recent Advances: At a
minimum, flaps are required to treat radiation ulcers. Surgeons can recommend
earlier debridement, followed by immediate coverage with axial-pattern
musculocutaneous and fasciocutaneous flaps. Free flaps are also a useful soft
tissue coverage option. The choice of flap varies with the location and size of
the wounds. Critical Issues: The most crucial procedure is the complete resection
of the radiation-affected area, followed by coverage with well-vascularized
tissue. Future Directions: Recent developments in perforator flap techniques,
which are defined as flaps with a blood supply from isolated perforating vessels
of a stem artery, have allowed the surgeons to successfully resurface these
difficult wounds with reduced morbidity.
DOI: 10.1089/wound.2012.0405
PMCID: PMC3900101
PMID: 24761342
