Local Radiation Injury and its Surgical Treatment: Report of 170 Cases

Abstract

170 cases of local radiation injury were treated by excision and immediate covering of the defect by various reconstructive methods. Initial diagnosis was in 32% benign diseases, in 44% skin carcinomas and in 24% deep malignant tumours. Postoperative histological diagnosis was nonulcerated atrophy in 24%, atrophic ulceration in 45%, necrotic ulceration in 9% and radiation-induced malignancy in 22%. The mean interval between radiation and operation was 12 years in cases of non-malignant radiation injury and 24 years in cases of malignant injury. In 81% irradiation had been given to the head and neck area and in only 6% to extremities. Basal cell carcinomas were six times as common as squamous cell carcinomas. As method of reconstruction, direct suture to eight by bone grafting. Cases of malignancy gen-41%, transposition flap in 8%, tube pedicle flap in 14% and bone graft in 2%. The mean number of operations per patient varied from one with reconstruction by direct suture to eight by bone grafting. Cases of malignancy generally required more operations. The mean time of post-operative control until the patient was considered cured was 1.6 years in nonmalignant cases. Malignant cases are controlled for the rest of their lives. The mortality rate in radiation-induced malignancy was 2.7%. One patient died during the postoperative recovery period. Surgical treatment is considered in regard to its timing and indications for different methods of reconstruction.