Radiation Ulcers Workup

Updated: Aug 25, 2021
  • Author: Martha Matthews, MD; Chief Editor: Joseph A Molnar, MD, PhD, FACS  more...
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Workup

Laboratory Studies

See the list below:

  • 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.

  • Check the prealbumin and albumin levels, which indicate whether the patient's wound healing capability is optimized.

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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]

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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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