Laboratory Studies
See the list below:
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Routine presurgical testing should be done, as indicated by the patient's age and comorbid conditions.
Nutritional parameters, such as albumin, prealbumin, and ferritin levels, should be obtained if suboptimal nutrition is a possibility.
Patients with chronic wounds are often debilitated, and they may have anemia due to chronic, minor blood loss.
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Check the prealbumin and albumin levels, which indicate whether the patient's wound healing capability is optimized.
Imaging Studies
Plain radiographs may be useful to look at the condition of the underlying bone and to screen for osteoradionecrosis. Computed tomography (CT) scanning or magnetic resonance imaging (MRI) may be useful in defining the extent of large, deep wounds and the involvement of underlying muscle and bone.
A study by Chen et al indicated that MRI findings in postradiation necrosis following treatment for nasopharyngeal carcinoma strongly correlate to clinical findings. In the study, which involved 67 patients with pathologically diagnosed postradiation nasopharyngeal necrosis, MRI findings consistent with radiation injury included local and extensive erosion, carotid exposure, and osteoradionecrosis. Despite the necrotic characteristics revealed by MRI, however, the investigators cautioned that pathologic examination is still required for an accurate diagnosis of nasopharyngeal necrosis. [12]
Other Tests
Biopsy and histology
Biopsy of suspicious wounds should be done to rule out malignancy (Marjolin ulcer).
A retrospective study by Liao et al indicated that in patients whose history of radiation exposure is unknown, fluoroscopic angiography–induced radiation ulcers can be distinguished from morphea by a variety of the ulcers’ characteristics, including association with bizarre fibroblasts, sclerosis, telangiectasia, and the loss of cutaneous appendages. In addition, in the majority of study patients who underwent angioplasty for coronary artery disease, the ulcer was located in the right subscapular region. [13]
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Case A. Cutaneous injury caused by irradiation of the chest wall to treat advanced lung cancer with metastases to the head and spine. This patient was transferred to a burn unit for adequate care of the burns and ulcerations caused by the radiation treatments.
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Case A. Cutaneous injury caused by irradiation to the chest wall to treat advanced lung cancer with metastases to the head and spine.
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Case A. Cutaneous injury caused by irradiation to treat advanced lung cancer with metastases to the head and spine. View illustrates radiation burns to the head and neck region. Note the residual silver sulfadiazine and mafenide acetate cream on the patient's face and ears, which was applied to treat the injury and prevent infectious complications.
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Case A. Cutaneous injury caused by irradiation to treat advanced lung cancer with metastases to the head and spine.
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Case A. Cutaneous injury caused by irradiation to treat advanced lung cancer with metastases to the head and spine.
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Case A. Cutaneous injury caused by irradiation to treat advanced lung cancer with metastases to the head and spine. View shows the posterior aspects of the patient's ears and neck.
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Case B. This patient presented to the plastic surgeon with complaints of a small opening along her mid sternum. She was receiving follow-up care from her primary physician, who had been treating the wound with parenteral antibiotics, with no improvement. The patient's history was noteworthy for previous left radical mastectomy followed by cobalt radiation approximately 20 years ago. At first glance, the wound appeared to be a small, draining sinus surrounded by the erythema typically seen with radiation-damaged skin.
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Case B. The patient was scheduled for debridement of the affected area. Use of a myocutaneous flap was planned because a large area of underlying osteonecrosis was suspected. Image depicts the extensively débrided chest wall. Most of the sternum and numerous costochondral cartilages were excised.
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Case B. Photograph obtained after a right-sided pectoralis major myocutaneous flap was used to close the resultant defect. The pectoralis muscle was disinserted at the shoulder to facilitate movement of the flap across the midline.
