Shack R B
South Med J. 1982 Dec;75(12):1462-6. doi: 10.1097/00007611-198212000-00005.
Despite more efficient and safer technics of radiation therapy, the problem of radiation-induced injury to the skin and soft tissue persists. The problem of adequate coverage of these painful, ischemic, and fibrotic ulcers remains challenging. Split-thickness skin grafts are seldom sufficient coverage, as the graft almost always has areas that do not take. Although these areas may eventually heal by epithelialization, the result is never ideal. Most often flap coverage is required, but elevation of local flaps is jeopardized because the tissue surrounding the ulcer crater frequently has been sufficiently compromised to cause loss of at least part of the flap. In the past, this necessitated use of pedicled flaps, tubed and transposed from a distance. With the development of axial-pattern musculocutaneous and muscle flaps, as well as microvascular free flaps, the difficulty in dealing with these ulcers has been decreased. Surgeons can now recommend earlier use of adequate debridement, many times of the entire irradiated area, and immediate coverage with a well vascularized axial-pattern musculocutaneous flap or revascularized free flap.
尽管放射治疗技术更加高效和安全，但皮肤和软组织的放射性损伤问题依然存在。充分覆盖这些疼痛、缺血和纤维化溃疡的问题仍然具有挑战性。断层皮片移植很少能提供足够的覆盖，因为移植皮片几乎总会有未成活的区域。尽管这些区域最终可能通过上皮化愈合，但结果并不理想。大多数情况下需要皮瓣覆盖，但局部皮瓣的掀起存在风险，因为溃疡创口周围的组织常常受到严重损害，导致至少部分皮瓣坏死。过去，这就需要使用带蒂皮瓣，从远处管状转移过来。随着轴型肌皮瓣和肌瓣以及微血管游离皮瓣的发展，处理这些溃疡的难度已经降低。外科医生现在可以建议更早地进行充分清创，多次对整个受照射区域进行清创，并立即用血管丰富的轴型肌皮瓣或血运重建的游离皮瓣覆盖。
