Radiation is often a necessary adjuvant in the treatment of many cancers. While radiation is often necessary in cancer therapy, the radiation can also cause damage to normal healthy tissue and prevent wound healing.
When radiation is used on the head, not only can it cause injury to the skin and subcutaneous tissue, it can also cause damage to the underlying bone. When the bone develops osteoradionecrosis, it can often cause wounds to recur or simply become non-healing. When the bone is removed, often a titanium mesh or bone cement is used to cover the brain.
Usually there is not enough tissue on the scalp to close these defects, therefore free tissue transfer and microsurgery is necessary to bring in healthy tissue to the area to close the wounds.
The rectus muscle is a nice muscle to use in this scenario as there is a long pedicle leash and a muscle with a large surface area. Occasionally the superficial temporal artery is of good quality and the vein may be small. In this case we have found that the saphenous vein can be an effective vein graft from the flap to the external jugular. We find that in the past many have not advocated the use of vein grafts. However, often is more advantageous to use a vein graft to a more suitable outflow than to rely on a marginal vein in the vicinity of the wound.
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