The Surgical Treatment of Irradiated Wounds: A Report on 36 Patients

Radiation therapy, although a useful modality for cancer therapy, injures the surrounding uninvolved tissues. Although surgery is often necessary for non-healing ulcers, surgery of irradiated wounds is recognized as challenging. In this study, we evaluate the outcomes and complications of patients who underwent surgical treatment of irradiated wounds. We reviewed 36 patients who underwent reconstructive surgery for irradiated wounds at our institution. A regional flap was applied in 17 patients, a local flap in 13 patients, a skin graft in 2 patients, and direct closure was performed in 4 patients. The complication rate was 65%, 69%, 50%, and 25%, respectively, and was not significantly different based on the type of reconstructive procedure used. Of the 30 patients who underwent flap reconstruction, 21 (70%) had flaps that included muscle and the remaining 9 patients (30%) had flaps that did not include muscle. The complication rate was 67% for both groups. Thus, the use of a muscle flap did not lead to superior outcomes. A radiation dose >60 Gy was correlated with a higher wound complication rate (p < 0.001). This study demonstrated that the use of regional flaps did not diminish the complication rate; moreover, contrary to previous reports, the use of muscle/musculocutaneous flaps did not reduce complications. Radiotherapy dose was the only factor associated with wound complications. Although reconstructive surgery of wounds irradiated with high-dose radiation was quite difficult, most of the irradiated wounds in our study were ultimately closed.