Dx: Delayed Radiation Injury
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Wound at presentation; patient unable to heal surgical wounding in previously irradiated tissue.
Status post 30 hyperbaric dives; wound now clean with improved tissue microcirculation and oxygenation.
Complete flap/graft healing at conclusion of therapy.
An 86-year-old male presented to The Center For Wound Healing in June 2005 with a chronic frontal scalp wound of one-year duration. The patient had a history of squamous cell carcinoma of the scalp initially treated by surgical resection in 1999. He was found to have a recurrent lesion in July 2004 and underwent high-dose radiation therapy in addition to topical and oral antibiotics.
The patient suffered recurrence of disease in May 2005 and subsequently underwent Mohs micrographic surgery followed by placement of a porcine xenograft for wound coverage. The patient ultimately failed all attempts to re-epithelialize the wound and was referred by his dermatologist for more advanced wound care options.
Upon presentation the patient was found to have a full-thickness defect of the frontal scalp measuring 6.0 cm x 3.5 cm x 0.3 cm. Desiccated, ischemic bone was observed at the base of the wound as a result of previous radiation to the area. Sparse slough and fibrinous debris remained adherent within the defect.
It was determined at this time that hyperbaric oxygen therapy (full-body monoplace chamber) was prescribed as part of a comprehensive surgical repair of the affected area. Hyperbaric oxygen induces neovascularization and improved oxygenation within previously irradiated bone and soft tissue to ensure an optimal environment for surgical repair and tissue survival.
Following 30 pre-operative hyperbaric oxygen therapy treatments (90 minutes @ 2.4 ATA), the patient underwent rotational tissue flap coverage of the primary defect with split-thickness skin graft repair of the resulting surgical wound. Ten additional Hyperbaric oxygen therapy treatments were performed post-operatively for metabolic support of the newly placed tissues during the critical phase of healing.
The patient experienced no post-operative complications with complete graft/flap take, and experienced improved quality of life.
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