Department of Plastic and Reconstructive Surgery, Seoul National University Hospital, Seoul 03080, Republic of Korea.
Hyundai Aesthetic Plastic Surgery, Seoul 06038, Republic of Korea.
Biomed Res Int. 2022 May 25;2022:3541254. doi: 10.1155/2022/3541254. eCollection 2022.
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. . 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.
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.
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.
放疗后迟发性头皮伤口的处理较为棘手，尤其是对于有颅内肿瘤手术史的患者。这些伤口通常先表现为伤口裂开或渗液，若不进行适当的外科治疗，通常无法自行愈合。然而，目前尚未确立明确的治疗指南。在此，我们报告了我们在放疗后头皮伤口治疗方面的临床经验，并提出了一种治疗此类伤口的手术原则。
回顾性分析 2000 年 1 月至 2015 年 8 月间收治的 13 例脑肿瘤患者的临床资料，这些患者因放疗后难治性头皮伤口而接受治疗。所有患者均因脑肿瘤而行开颅手术。根据“重建阶梯”，并结合骨瓣和头皮组织的状况，决定迟发性头皮伤口的外科治疗方案。记录患者的临床特征以及与放疗、手术和术后并发症相关的信息。
放疗后头皮伤口平均在 4.4 年后出现。平均进行了 2.3 次翻修手术，其中 6 例（46%）需要进行 2 次以上手术。11 例（84.6%）患者去除骨瓣后伤口完全愈合，其中 3 例患者使用人工材料行颅骨成形术，但 2 例因伤口问题复发而去除骨瓣。
放疗后头皮伤口的治疗较为困难，且复发风险较高。如果怀疑发生放射性骨坏死，应去除骨瓣。积极清创和使用健康组织覆盖缺损非常重要。
