Management of radiation wounds

Abstract

Radiotherapy forms an integral part in cancer treatment today. It is used alone or in combination with surgery and chemotherapy. Although radiotherapy is useful to effect tumour death, it also exerts a deleterious effect on surrounding normal tissues. These effects are either acute or can manifest months or years after the treatment. The chronic wounds are a result of impaired wound healing. This impairment results in fibrosis, nonhealing ulcers, lymphoedema and radionecrosis amongst others. This article will discuss the pathophysiology in brief, along with the manifestations of radiation-induced injury and the treatment available currently.

Keywords: Lymphoedema; osteoradionecrosis; plexopathy; radiotherapy; wounds.

Figure 1

A 40-year-old female patient post laryngectomy who received postoperative chemoradiation. There is intense fibrosis of the neck and remnant pharynx resulting in a stricture. The patient is being prepared for correction of the fibrosis and stricture with a tubed anterolateral thigh flap

Figure 2

Nonhealing chest wound in a patient who had a mastectomy followed by radiotherapy

Figure 3

A latissimus dorsi free flap was used to cover the defect, but the healing was impaired because of the postradiotherapy status

Figure 4

The wound was debrided and a pectoralis major muscle flap from the opposite chest was used to cover the deficient area

Figure 5

A split skin graft was placed over the pectoralis major muscle

Figure 6

Osteoradionecrosis in a 50-year-old male patient