The Pathogenesis And Treatment Of Chronic Radiation Induced Skin Injury

Objective: To investigate the pathogenesis of chronic radiation skin injury and discuss the treatment.Methods: We have cured 7 cases of different radiation induced ulcer patients since March 2008. The sites of ulcers are face, chest, axillary fossa, back, groin and sacrococcygeal region. The largest Ulcer is 12.0 cm×12.0 cm and the smallest is 2.0 cm×2.2 cm. The ulcers have reach the muscles, 1 case accompany with bone exposed. One patient refused surgery, the remain 6 patients underwent elcotomy followed with flap graft.Results: Tow patients occurred with tissue liquefaction and 1 with infection after surgery. All 6 flaps survived through drainage, anti-infection and necessary re-debridement. There was no ulcer recurrence in our follow up.Conclusion: There are a variety of pathogenesis with chronic radiation induced skin injury, include radiation caused microvascular damage and a variety of abnormal cytokine expression. The involved cytokines are transforming growth factorβ, connective tissue growth factor, platelet-derived growth factor, basic fibroblast growth factor, interleukin and so on. They are activated by various signaling and promote myofibroblasts produce extracellular matrix and eventually fibrosis occured. We have to prevent fibrosis from rupture and infection, the exact method of anti-fibrosis is still unknown. Chronic radiation induced ulcer is difficult to heal, surgical excision should be taken and covered with rich blood supply flap can reach a good therapeutic effect. We need to exclude tumor recurrence and malignant ulcers before operation. Debridement surgery needs to achieve the ulcer edge of the range of 1cm, but it depends on the specific lesion. Patients with a history of radiotherapy should be followed up regularly and to get early diagnosis and treatment.