The surgical treatment of radiation dermatitis following irradiation of benign diseases

Abstract

A survey is presented of plastic surgical techniques used in 80 patients with radiation dermatitis after exposure to x rays, either accidentally or for a benign disease. The patients illustrate that the use of radiation for treatment of benign disease may be disastrous. All 80 patients with radiation dermatitis had such symptoms from the dermatitis as pruritus, burning, and/or ulceration. The majority of the 80 patients had been given radiation treatment for lesions that were cosmetically unacceptable, in an attempt to improve the appearance of the patient, but the results indicate that it would have been better if the original lesions had been allowed to remain. In 46 irradiated patients (57%) in whom malignancy developed, the incidence of squamous and basal cell carcinoma was almost equal. The average and median time between exposure and diagnosis of malignancy was 27 yr; however, the range was from 9 to 40 yr and the standard deviation was 8.9 yr. In most instances the patients with radiodermatitis who later developed cancer had a history of recurrent ulceration. Surgical treatment consisted usually of excision of the affected area followed by grafting of the skin, although occasionally simple excision and closure were possible. Amputation and/or coveragemore » of the pedicle flap were required in many cases. Since deeper tissues were often severely damaged too, there was a high incidence of failure of the intital graft. There was much oozing from fine teleangiectatic vessels when excision was performed, and hematomas occurred frequently and contributed to the incidence of failure of grafts. Only 17 patients were considered to have made satisfactory recovery from the sequelae of radiodermatitis. (TCO)« less