OBJECTIVE: To explore a method to repair severe radiation-induced ulcer and evaluate its clinical effects. METHODS: From August 1988 to December 1998, 12 cases of severe radiation-induced ulcer were treated by muscular or musculocutaneous flap transfer, which included 1 case of pectoralis major muscular flap, 3 cases of three-lobed transverse rectus abdominis musculocutaneous flap, 2 cases of latissimus dorsi musculocutaneous flap, 1 case of tensor fascia lata musculocutaneous flap, 1 case of longitudinal rectus abdominis musculocutaneous and tensor fascia lata musculocutaneous flap, 1 case of gastrocnemius muscular flap, 1 case of gluteus major musculocutaneous flap, huge filleted musculocutaneous flap from lower limbs in 1 case and from upper limbs in 1 cases. RESULTS: All the flaps survived. Primary healing occurred in 9 cases and secondary healing in 3 cases. The extensive multiple ulcers in 2 cases were repaired with filleted limb musculocutaneous flap, and patients were saved. And in other 3 cases, the chest wall defect as the result of radionecrosis were repaired with simultaneous breast reconstruction. CONCLUSION: Muscular or musculocutaneous flaps have abundant blood supply, they are ideal tissue to fill the cavity and repair the defect, especially in repairing severe radiation-induced ulcers.
The experience of the treatment of 5 thoracic ulcers and 1 large and deep neck ulcer was reported. Vascularized latissimus dorsi and rectus abdominis myocutaneous flaps were used to treat the ulcers with one failure. No recurrence was foundduring the followup from one to five years. In the early stage of acute inflammatory necrosis, treatment was focused on debridement. In order to remove the necrotic tissue and provide good drainage, it was not appropriate to cover the wound immediately. In the chronic stage, the radiation ulcers with their adjacent tissues should be excised. Island myocutaneous flap and axial pattern skin flap were selected to repair the wound. If the wound was too large, two flaps may be combined to cover it. No matter what kind of flap was chosen, the donor site should be far away from the ulcer.