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.
Closure of the radiated wound is often one of the most challenging problems the Plastic & Reconstructive Surgeon can face. The key to closing radiated wounds is adequate debridement. Often adequate debridement can create a much larger wound that the original and often much larger than anticipated by both patient and surgeon.
After adequate debridement has been performed, the next important step in reconstruction is to make sure that healthy tissue is brought into the area affected to allow wound closure. In some cases, tissue from an adjacent area of the body can be used, occasionally regional tissue may be used, and in some cases distant tissue is used to be brought into the area to allow wound closure. When tissue from a remote area of the body is used, this is called free tissue transfer or microsurgical anastomosis.
In this case a large posterior trunk wound was present after successful cancer removal and successful radiation therapy. The wound was thoroughly debrided to relatively healthy tissue. A wound VAC was then placed on the posterior trunk to promote blood perfusion and as a bridge to determine the final wound size and plan reconstruction.
In this case, a latisimus myocutaneous flap was used to bring both muscle to cover exposed bone and skin to fill a defect. A small skin graft was placed on the latisimus muscle to prevent too tight of a wound closure. The skin graft however contracts over time and can often eventually be excised and the wound closed with one skin paddle.
