Close
New

Medscape is available in 5 Language Editions – Choose your Edition here.

 

Radiation Ulcers Workup

  • Author: Martha Matthews, MD; Chief Editor: Joseph A Molnar, MD, PhD, FACS  more...
 
Updated: Mar 15, 2016
 

Laboratory Studies

See the list below:

  • Routine presurgical testing should be done, as indicated by the patient's age and comorbid conditions.
    • Nutritional parameters, such as albumin, prealbumin, and ferritin levels, should be obtained if suboptimal nutrition is a possibility.
    • Patients with chronic wounds are often debilitated, and they may have anemia due to chronic, minor blood loss.
  • Check the prealbumin and albumin levels, which indicate whether the patient's wound healing capability is optimized.
Next

Imaging Studies

Plain radiographs may be useful to look at the condition of the underlying bone and to screen for osteoradionecrosis. Computed tomography (CT) scanning or magnetic resonance imaging (MRI) may be useful in defining the extent of large, deep wounds and the involvement of underlying muscle and bone.

A study by Chen et al indicated that MRI findings in postradiation necrosis following treatment for nasopharyngeal carcinoma strongly correlate to clinical findings. In the study, which involved 67 patients with pathologically diagnosed postradiation nasopharyngeal necrosis, MRI findings consistent with radiation injury included local and extensive erosion, carotid exposure, and osteoradionecrosis. Despite the necrotic characteristics revealed by MRI, however, the investigators cautioned that pathologic examination is still required for an accurate diagnosis of nasopharyngeal necrosis.[10]

Previous
Next

Other Tests

See the list below:

  • Biopsy of suspicious wounds should be done to rule out malignancy (Marjolin ulcer)
Previous
 
 
Contributor Information and Disclosures
Author

Martha Matthews, MD Associate Professor of Surgery, Cooper Medical School of Rowan University

Martha Matthews, MD is a member of the following medical societies: American Cleft Palate-Craniofacial Association, American Society of Plastic Surgeons, New Jersey Society of Plastic Surgeons, American College of Surgeons, American Society of Maxillofacial Surgeons

Disclosure: Nothing to disclose.

Coauthor(s)

Heidi D Williams, MD Private Practice Mt. Pleasant, South Carolina

Disclosure: Nothing to disclose.

Specialty Editor Board

Francisco Talavera, PharmD, PhD Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Received salary from Medscape for employment. for: Medscape.

Wayne Karl Stadelmann, MD Stadelmann Plastic Surgery, PC

Wayne Karl Stadelmann, MD is a member of the following medical societies: Alpha Omega Alpha, American College of Surgeons, American Society of Plastic Surgeons, New Hampshire Medical Society, Northeastern Society of Plastic Surgeons, Phi Beta Kappa

Disclosure: Nothing to disclose.

Chief Editor

Joseph A Molnar, MD, PhD, FACS Medical Director, Wound Care Center, Associate Director of Burn Unit, Professor, Department of Plastic and Reconstructive Surgery and Regenerative Medicine, Wake Forest University School of Medicine

Joseph A Molnar, MD, PhD, FACS is a member of the following medical societies: American Medical Association, American Society for Parenteral and Enteral Nutrition, American Society of Plastic Surgeons, North Carolina Medical Society, Undersea and Hyperbaric Medical Society, Peripheral Nerve Society, Wound Healing Society, American Burn Association, American College of Surgeons

Disclosure: Received grant/research funds from Clinical Cell Culture for co-investigator; Received honoraria from Integra Life Sciences for speaking and teaching; Received honoraria from Healogics for board membership; Received honoraria from Anika Therapeutics for consulting; Received honoraria from Food Matters for consulting.

References
  1. Ramos M, Montoro A, Almonacid M, Barquinero SF, Tortosa R, Miro R, et al. Biological and physical methods for risk estimation in interventional radiology: A detrimental effect approach. Conf Proc IEEE Eng Med Biol Soc. 2011 Aug. 2011:108-11. [Medline].

  2. Wei KC, Yang KC, Mar GY, et al. STROBE-Radiation Ulcer: An Overlooked Complication of Fluoroscopic Intervention: A Cross-Sectional Study. Medicine (Baltimore). 2015 Dec. 94 (48):e2178. [Medline]. [Full Text].

  3. O'Sullivan B, Levin W. Late radiation-related fibrosis: pathogenesis, manifestations, and current management. Semin Radiat Oncol. 2003 Jul. 13(3):274-89. [Medline].

  4. Miller SH, Rudolph R. Healing in the irradiated wound. Clin Plast Surg. 1990 Jul. 17(3):503-8. [Medline].

  5. Guelinckx PJ, Boeckx WD, Fossion E, Gruwez JA. Scanning electron microscopy of irradiated recipient blood vessels in head and neck free flaps. Plast Reconstr Surg. 1984 Aug. 74(2):217-26. [Medline].

  6. Xu Y, Parmar K, Du F, Price BD, Sun Y. The radioprotective agent WR1065 protects cells from radiation damage by regulating the activity of the Tip60 acetyltransferase. Int J Biochem Mol Biol. 2011. 2(4):295-302. [Medline]. [Full Text].

  7. Rudolph R, Arganese T, Woodward M. The ultrastructure and etiology of chronic radiotherapy damage in human skin. Ann Plast Surg. 1982 Oct. 9(4):282-92. [Medline].

  8. Rudolph R, Tripuraneni P, Koziol JA, et al. Normal transcutaneous oxygen pressure in skin after radiation therapy for cancer [published erratum appears in Cancer 1995 Mar 1;75(5):1218]. Cancer. 1994 Dec 1. 74(11):3063-70. [Medline].

  9. Tattini C, Manchio J, Zaporojan V, et al. Role of TGF-beta and FGF in the treatment of radiation-impaired wounds using a novel drug delivery system. Plast Reconstr Surg. 2008 Oct. 122(4):1036-45. [Medline].

  10. Chen MY, Mai HQ, Sun R, et al. Clinical findings and imaging features of 67 nasopharyngeal carcinoma patients with postradiation nasopharyngeal necrosis. Chin J Cancer. 2013 Oct. 32(10):533-8. [Medline]. [Full Text].

  11. Bennett MH, Feldmeier J, Hampson N, Smee R, Milross C. Hyperbaric oxygen therapy for late radiation tissue injury. Cochrane Database Syst Rev. 2012 May 16. 5:CD005005. [Medline].

  12. Fujioka M. Surgical Reconstruction of Radiation Injuries. Adv Wound Care (New Rochelle). 2014 Jan 1. 3 (1):25-37. [Medline]. [Full Text].

  13. Watson JS. Experimental microvascular anastomoses in radiated vessels: a study of the patency rate and the histopathology of healing. Plast Reconstr Surg. 1979 Apr. 63(4):525-33. [Medline].

  14. Mulholland S, Boyd JB, McCabe S, et al. Recipient vessels in head and neck microsurgery: radiation effect and vessel access. Plast Reconstr Surg. 1993 Sep. 92(4):628-32. [Medline].

  15. Rigotti G, Marchi A, Galie M, Baroni G, Benati D, Krampera M. Clinical treatment of radiotherapy tissue damage by lipoaspirate transplant: a healing process mediated by adipose-derived adult stem cells. Plast Reconstr Surg. 2007 Apr 15. 119(5):1409-22; discussion 1423-4. [Medline].

  16. Payne WG, Naidu DK, Wheeler CK, et al. Wound Healing in Patients With Cancer. Eplasty. 2008 Jan 11. 8:e9. [Medline].

  17. Grdina D, Murley J, Kataoka Y. Radioprotectants: Current Status and New Directions. Oncology. 2002. 63(suppl2):2-10. [Medline].

  18. Ariyan S. Radiation injury. Plastic Surgery. 2nd ed. 2006. Vol 1: 835-53.

  19. Bennett MH, Feldmeier J, Hampson N, Smee R, Milross C. Hyperbaric oxygen therapy for late radiation tissue injury. Cochrane Database Syst Rev. 2005 Jul 20. CD005005. [Medline]. [Full Text].

Previous
Next
 
Case A. Cutaneous injury caused by irradiation of the chest wall to treat advanced lung cancer with metastases to the head and spine. This patient was transferred to a burn unit for adequate care of the burns and ulcerations caused by the radiation treatments.
Case A. Cutaneous injury caused by irradiation to the chest wall to treat advanced lung cancer with metastases to the head and spine.
Case A. Cutaneous injury caused by irradiation to treat advanced lung cancer with metastases to the head and spine. View illustrates radiation burns to the head and neck region. Note the residual silver sulfadiazine and mafenide acetate cream on the patient's face and ears, which was applied to treat the injury and prevent infectious complications.
Case A. Cutaneous injury caused by irradiation to treat advanced lung cancer with metastases to the head and spine.
Case A. Cutaneous injury caused by irradiation to treat advanced lung cancer with metastases to the head and spine.
Case A. Cutaneous injury caused by irradiation to treat advanced lung cancer with metastases to the head and spine. View shows the posterior aspects of the patient's ears and neck.
Case B. This patient presented to the plastic surgeon with complaints of a small opening along her mid sternum. She was receiving follow-up care from her primary physician, who had been treating the wound with parenteral antibiotics, with no improvement. The patient's history was noteworthy for previous left radical mastectomy followed by cobalt radiation approximately 20 years ago. At first glance, the wound appeared to be a small, draining sinus surrounded by the erythema typically seen with radiation-damaged skin.
Case B. The patient was scheduled for debridement of the affected area. Use of a myocutaneous flap was planned because a large area of underlying osteonecrosis was suspected. Image depicts the extensively débrided chest wall. Most of the sternum and numerous costochondral cartilages were excised.
Case B. Photograph obtained after a right-sided pectoralis major myocutaneous flap was used to close the resultant defect. The pectoralis muscle was disinserted at the shoulder to facilitate movement of the flap across the midline.
 
 
 
All material on this website is protected by copyright, Copyright © 1994-2016 by WebMD LLC. This website also contains material copyrighted by 3rd parties.