Repair of chronic radiation wounds of the pelvis.

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AbstractRadiation therapy is currently utilized for primary or adjuvant therapy for pelvic tumors. Although improvements in radiation delivery techniques have largely eliminated acute complications in the radiation field, occurrences of late wound complications persist and result in complex pelvic and perineal wounds. Since these wounds reflect underlying impaired local circulations secondary to obliterative endarteritis, local wound management frequently fails either to control secondary infection or to allow spontaneous wound closure. Twenty‐four patients with chronic pelvic wounds have recently undergone successful wound repair with use of muscle, musculocutaneous, and fasciocutaneous flaps. This review of these patients will demonstrate the physiologic basis for vascularized flaps for wound closure. Specific flap selection is based on the location of the pelvic radiation wound in the anterior pelvis and inguinal region, perineum and pelvic cavity, and sacrum. Well‐vascularized flaps must have an independent source of circulation distant to the site of radiation damage for reliable wound coverage. Muscle and skin fascial flaps are available based on reliable pedicles located in the anterior abdominal wall, anterior and posterior thigh, and posterior pelvic region with adequate arc of rotation to cover most pelvic defects. Flaps frequently utilized in this study included: rectus femoris, rectus abdominis, gracilis, and gluteus maximus muscle and musculocutaneous flaps, and the gluteal thigh skin fascial flap. Wound debridement and simultaneous coverage with well‐vascularized flaps have been established as a useful and reliable method to repair complex wounds of pelvic radiation necrosis.