RADIATION INJURY AND ITS SURGICAL TREATMENT
Common types of radiation injury, particularly to the skin, resulting from radiotherapy are described and plastic surgical repair in seven cases of x- ray burns are illustrated. Few radiologists realize how common radiation necrosis is, firstly, because the patient who has been burned often does not return to the radiologist who inflicted the burn, and secondly, the serious effects, for example ulceration and malignant change, often do not occur until years after the original burn. Acute radiodermatitis is more commonly found when a rather large dose is given over a relatively short period of time. The skin reaction is primarily iiiflammatory, and development of carcinoma is not commonly seen in the early phase. There may be a prolonged latent period between the time of the original treatment and clinical evidence of radiodermatitis. Deformities may develop in a child following extensive radiation; severe retardation of growth produces irreversible change. It should be recognized that skin sensitivity to radiation varies greatly with different individuals, the classic example of sensitive skin being that in people with red hair. A mild dosage to the red-head's skin can frequently produce a severe reaction and damage, while the same dosage to the average person with more pigmented skin may show no effect of radiation. It is, therefore, probable that the majority of people with deeply pigmented skins may have greater natural resistance to the effects of radiation. The recommended treatment of irradiation injuries is surgical, with complete removal of diseased tissue and immediate coverage of the resultant wound, either by means of a free skin graft or a pedicle flap. The excision of all radiation lesions must be well wide of the involved area and to a depth that brings viable healthy bleeding tissue. If malignant changes are suspected, the surgeon must be certain that wide removal is obtained in all directions. Cautery must never be used for hemostasis because this causes further damage to the blood supply. Some physicians treat malignancies secondary to radiation with further radiation therapy, but this is definitely contraindicated. Different methods of closure following removal of the involved tissue are discussed. Small wounds may be closed by approximation but frequently skin grafts are indicated for coverage. Conservative treatment in radiation injuries usually fails to effect a cure. Split-thickness skin grafts are recommended on non-weight bearing areas and where no vital structures are exposed, especially in older persons. Use of pedicle flaps to repair large necrotic areas over vital structures is also described. Successful application of these techniques in seven patients is outlined. (BBB)
- Research Organization:
- Univ. of Oregon, Portland
- NSA Number:
- NSA-17-035384
- OSTI ID:
- 4660466
- Journal Information:
- Northwest Medicine (U.S.), Vol. Vol: 62; Other Information: Orig. Receipt Date: 31-DEC-63
- Country of Publication:
- Country unknown/Code not available
- Language:
- English
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