Surgical Treatment of Radiation-Induced Late-Onset Scalp Wound in Patients Who Underwent Brain Tumor Surgery: Lessons from a Case Series

Objective. The management of late-onset scalp wounds following irradiation is troublesome, especially in patients with a surgical history of intracranial neoplasms. It, insidiously, starts with wound dehiscence or discharge and never heals spontaneously without appropriate surgical treatment. Nevertheless, definite treatment guidelines have not yet been established. Here, we present our clinical experience with radiation-induced scalp wounds and suggest a surgical principle for their treatment. Patients and Methods. The medical records of 13 patients with brain tumors, who were treated for intractable scalp wounds after irradiation between January 2000 and August 2015, were retrospectively reviewed. All the patients underwent a craniotomy for brain tumor resection. Surgical treatment for a late-onset scalp wound was decided based on the "reconstructive ladder" and according to the status of bone flap and scalp tissue. The patients' clinical characteristics and information regarding irradiation, surgery, and postoperative complications were recorded. Results. Scalp wounds developed 4.4 years, on average, after the completion of irradiation. Revision operations were performed an average of 2.3 times, and 6 patients (46%) required more than 2 operations. The bone flap was removed in 11 patients (84.6%) to achieve complete wound healing. Among them, 3 patients underwent a cranioplasty using artificial materials, but 2 patients underwent removal due to recurrent wound problems. Conclusions. Postirradiation scalp wounds are difficult to treat and have a high risk of recurrence. If osteoradionecrosis is suspected, the bone flap should be removed. It is important to debride unhealthy tissues aggressively and cover defects with robust tissue.