Plastic Surgery in Chronic Radiodermatitis and Radionecrosis

The widespread use of radium and X rays as therapeutic agents and their well-recognised potency for evil as well as for good has not unnaturally resulted in a considerable number of cases of chronic dermatitis. While many of these have been due to over-treatment or to inadequate protection of the patient, not a few have occurred in the practice of the most skilful, and in patients whose treatment omitted no precaution. It is apparent that in such instances individual susceptibility is an important factor. That the number is large is indicated by the fact that more than forty cases have presented themselves for surgical treatment in the past few years. If these have filtered through to one clinic, it is probable that there are many more untreated cases throughout the country. For instance, most of the old lupus cases show the late effects of radiated skin. While many of the milder degrees of burn heal, at least for a time, under medical treatment, chronic ulcerative radiodermatitis, once established, admits of one form of treatment only. Complete excision is followed by rapid relief of symptoms and freedom from the risk of carcinomatous change. Cure, however, cannot be considered as satisfactorily attained if no attempt is made to avoid the secondary contraction which follows healing by granulation. Thus, the problem of the immediate replacement of the excised tissue with healthy skin brings the condition naturally within the purview of the plastic surgeon.