Radiotherapy is an invaluable weapon when treating cancer. However, the deleterious effects of radiation, both immediate and long-term, may have a significant effect on local tissues. Problematic wound healing in radiation-damaged tissue constitutes a major problem that is frequently overlooked during the management of patients who require radiotherapy, or have had radiotherapy in the past. Poor wound healing may lead to chronic ulceration, pain, secondary infection and psychological distress and compromise the outcome of general or reconstructive surgery. We discuss the pathophysiology of poor wound healing following radiotherapy, specific problems for radiation-damaged tissue and potential treatments to improve wound healing of irradiated tissues.

Frostbite, once almost exclusively a military problem, is becoming more prevalent among the general population and should now be considered to be within the scope of the civilian physician's practice. Studies into the epidemiology of civilian frostbite have identified several risk factors that may aid the clinician in the diagnosis and management of cold injuries. Research into the pathophysiology has revealed marked similarities in inflammatory processes to those seen in thermal burns and ischemia/reperfusion injury. Evidence of the role of thromboxanes and prostaglandins has resulted in more active approaches to the medical treatment of frostbite wounds. Although the surgical management of frostbite involves delayed debridement 1 to 3 months after demarcation, recent improvements in radiologic assessment of tissue viability have led to the possibility of earlier surgical intervention. In addition, several adjunctive therapies, including vasodilators, thrombolysis, hyperbaric oxygen, and sympathectomy, are discussed.

Vacuum-assisted closure (V.A.C. Therapy) uses 2 distinct types of foams, with different physical characteristics: the black polyurethane (PU) foam and the white polyvinyl alcohol (PVA) foam. This prospective, randomized study evaluates the response of cutaneous blood flow (CBF) in healthy intact forearm skin to varying V.A.C. Therapy negative pressures and both foam types. Continuous negative pressure was used in the range of 25-500 mmHg. Skin blood flow was measured with noninvasive laser Doppler probes incorporated into the foam. Significant increase in CBF was found with both foams up to negative pressure of 300 mmHg, with over 5-fold increase (mean: 5.57; SD: 3.32) with the PU foam and nearly 3-fold increase (mean: 2.87; SD: 1.29) with the PVA foam. Comparison of blood flow at baseline and at a negative pressure of 300 mmHg showed a statistically significant difference (P< 0.001). No decrease in blood flow below baseline was observed during the experiments.

Topical negative pressure is a novel non-pharmacological therapy that is now being adopted as a standard of care in wound care management programmes. This review assesses where and how it can be best used.

Necrotising fasciitis is a rare infection of the subcutaneous tissues. If untreated, it is invariably fatal, and thus a high index of suspicion for the diagnosis is required. The disease's manifestation can range from a fulminant presentation to a subtle and insidious development. The priority in every case is to proceed to radical surgical debridement. On review of the literature and based on our clinical experience, we propose a new classification based on clinical presentation and suggest an algorithm to facilitate the management of this devastating condition. Increasing awareness should be given to the management of the large wounds resulting from the surgical debridement of necrotising fasciitis.