Wound healing in radiated skin: pathophysiology and treatment options

Abstract

Ulcers in radiated skin continue to be a challenge for health care practitioners. Healing impairment in the setting of radiation-damaged tissue will most of the time lead to chronic wounds that reduce the patient's quality of life. In this review, we present an update of the pathophysiology of tissue damage caused by radiation that leads to chronic ulceration. We also explore the evidence available on the different prevention and treatment modalities that have been reported in the literature. The evidence for most preventive measures is inconclusive; however, sucralfate and amifostine seem to be the adequate recommendations for prophylaxis. As for treatment of ulcerated patients, the strongest level of evidence found was for the use of pentoxifylline, but proper trials are still scarce to be considered standard adjuvant therapy. Hyperbaric oxygen, cytokines and other growth factors and surgical interventions have shown some benefit in case reports and case series only. Other therapies show promise based on their mechanism of action but need to be tested in human studies and clinical trials.

Radiotherapy and wound healing: Principles, management and prospects (Review)

“…there is a great variability in the risk of developing radiation side effects. In part, this can be ascribed to differences in treatment and in patient characteristics (68). however, the pathophysiology of wound healing in the radiated skin is for the most part only theoretical.…”

“…early skin reactions after radiotherapy are usually moderate, but over 90% of patients treated with radiotherapy develop skin reactions (68). these reactions appear in the early stages as erythema and as dry desquamation.…”

Hyperspectral imaging for early detection of oxygenation and perfusion changes in irradiated skin

“…Long-term radiation-induced cutaneous complications include fibrosis, atrophy, induration, and secondary malignancy. 5 Studies examining acute oxygenation and perfusion changes (<1 month) in irradiated fields are limited. Two current modalities used to evaluate these parameters are laser Doppler flowmetry (LDF) and transcutaneous oxygen-tension probes.…”

Influence of backscatter radiation on cranial reconstruction implants

“…In addition, radiation induces changes in the skin and subcutaneous tissues that lead to skin atrophy and friability. 12,13 As a result, radiotherapy sometimes leads to skin ulcers. To minimize the risk of skin ulcers, the dose of radiation to the skin should be as low as possible.…”