Management of fluoroscopy-induced radiation ulcer: One-stage radical excision and immediate reconstruction

With increasing use of cardiac fluoroscopic intervention, the incidence of fluoroscopy-induced radiation ulcer is increasing. Radiation ulcer is difficult to manage and currently there are no treatment guidelines. To identify the optimal treatment approaches for managing cardiac fluoroscopy-induced...

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Bibliographic Details
Published in:Scientific reports 2016-10, Vol.6 (1), p.35875-35875, Article 35875
Main Authors: Wei, Kai-Che, Yang, Kuo-Chung, Chen, Lee-Wei, Liu, Wen-Chung, Chen, Wen-Chieh, Chiou, Wen-Yen, Lai, Ping-Chin
Format: Article
Language:English
Subjects:
692/4019/2776
692/700/565/545/488
Adult
Aged
Aged, 80 and over
Fascia
Fluoroscopy
Fluoroscopy - adverse effects
Gamma Rays
Heart
Heart diseases
Humanities and Social Sciences
Humans
Hyperbaric oxygen therapy
Male
Medical records
Middle Aged
multidisciplinary
Radiation Injuries - etiology
Retrospective Studies
Science
Skin
Skin Ulcer - etiology
Skin Ulcer - surgery
Surgical Flaps
Treatment Outcome
Ulcers
Wounds
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Summary:With increasing use of cardiac fluoroscopic intervention, the incidence of fluoroscopy-induced radiation ulcer is increasing. Radiation ulcer is difficult to manage and currently there are no treatment guidelines. To identify the optimal treatment approaches for managing cardiac fluoroscopy-induced radiation ulcers, we retrospectively reviewed medical records of 13 patients with fluoroscopy-induced radiation ulcers receiving surgical interventions and following up in our hospital from 2012 to 2015. Conventional wound care and hyperbaric oxygen therapy were of little therapeutic benefit. Twelve patients received reconstruction with advancement flap or split thick skin graft. One-stage radical excision of radiation damaged area in eight cases with immediate reconstruction led to better outcomes than conservative excisions in four cases. Radical surgical excision to remove all the radiation damaged tissues in combination with immediate reconstruction appears to offer the optimal treatment results for cardiac fluoroscopy-induced radiation ulcers. Adequate excision of the damaged areas in both vertical (to the muscular fascia) and horizontal (beyond the sclerotic areas) dimension is pivotal to achieve good treatment outcomes.
ISSN:2045-2322
2045-2322
DOI:10.1038/srep35875