Wound healing in radiated skin: pathophysiology and treatment options

Abstract

Ulcers in radiated skin continue to be a challenge for health care practitioners. Healing impairment in the setting of radiation-damaged tissue will most of the time lead to chronic wounds that reduce the patient's quality of life. In this review, we present an update of the pathophysiology of tissue damage caused by radiation that leads to chronic ulceration. We also explore the evidence available on the different prevention and treatment modalities that have been reported in the literature. The evidence for most preventive measures is inconclusive; however, sucralfate and amifostine seem to be the adequate recommendations for prophylaxis. As for treatment of ulcerated patients, the strongest level of evidence found was for the use of pentoxifylline, but proper trials are still scarce to be considered standard adjuvant therapy. Hyperbaric oxygen, cytokines and other growth factors and surgical interventions have shown some benefit in case reports and case series only. Other therapies show promise based on their mechanism of action but need to be tested in human studies and clinical trials.

Figure 1

Radiation‐induced damage where atrophy, lack of adnexa, skin fragility and ulceration developed after treatment for breast cancer in this male patient.

Figure 2

Microscopic chronic changes associated with radiodermits. Note epidermal atrophy, dilated blood vessels, loss of hair and glands and sclerosis.

Figure 3

Modified wound care paradigm for the management of patients with URS. Adapted from Sibbald et al. (44). HBOT, hyperbaric oxygen therapy; IFN‐γ, interferon‐gamma; PDGF, platelet‐derived growth factor.