Tolerance of skin grafts to postoperative radiotherapy

Abstract

Aim:The aim was to evaluate the integrity and functional outcomes of skin grafts following external beam radiotherapy (EBRT).Materials and Methods:A prospective study of 15 patients, in whom EBRT was planned after their wound coverage with split-thickness skin graft (STSG). Parameters evaluated include defect size, time to postoperative radiotherapy, total radiotherapy dose, delays and interruptions in radiotherapy, wound complications, and the need for further surgical interventions.Results:In all the 15 (6 men, 9 women) patients of STSG, radical doses of EBRT, that is, 50–70 Gy in 25–35 fractions are delivered over around 6 weeks. All STSGs were placed on healthy vascular tissue beds. Median time to initial radiotherapy after grafting was 3 weeks (range 3–6 weeks). There were no interruptions in radiotherapy treatment. In one patient, there was partial skin graft loss after radiotherapy that was adequately managed with conservative treatment. No patient requires further surgical intervention.Conclusion:Adjuvant postoperative radiotherapy can be delivered to STSGs without significant complications. Postoperative radiotherapy can be started as early as 3–4 weeks after skin grafting. Skin grafts should be placed on well-vascularized healthy tissues. Minor skin graft loss resulting from postoperative radiotherapy can usually be treated conservatively.

Conditions Associated with Wound Healing Complications After Adjuvant Radiotherapy in Patients with Non-Melanoma Skin Cancer: A Retrospective Analysis

“…Artamanova et al also observed that full thickness skin grafts were associated with necrosis [1]. Lal et al reported no increased WHCs after radiation in skin grafts, but the study included only 15 patients and their median age was 52 years, while the median age in the present study was 77 years [27]. Bui et al also reported no increased occurrence of WHCs in split thickness skin grafts after irradiation [26].…”

“…Sumi et al discovered that the reaction of skin grafts on rats to irradiation depends on the time interval between the transplantation and radiotherapy [11,18,24,28,29]. Skin grafts that were irradiated in the early hypovascular stage (2 days) reacted mildly to moderately, those irradiated in the hypervascular stage (2 days -3 weeks) reacted severely and those irradiated in the late hypervascular stage (3-4 weeks) reacted similarly to normal skin [18,24,27,30]. They also showed a similar course for irradiated skin flaps, which reacted akin to normal skin in the late hypervascular stage (3-4 weeks) [25].…”

“…The analysis of a greater number of patient data might investigate further risk factors for WHC, which were not significantly correlated with WHC in this study. However, to the best of the authors' knowledge, previous studies which investigated potential risk factors for WHC after radiation therapy included much smaller patient cohorts [15,[24][25][26][27]. As the authors analyzed previously collected patient data, they relied on the documentation in the electronic medical record.…”

Results of Split Thickness Skin Grafts after Scalp Rotation Flap Surgeries: A Cross-Sectional Study

“…(21) The use of skin grafts for fault coverage in patients who received irradiation following neighbouring tissue transfer has provided satisfactory outcomes. (22) We observed in our study that 5 out of 7 had 100% graft taken following radiation therapy; graft failure was observed in only one patient. These findings show that in individuals with numerous disorders for whom protracted anesthesia is judged inadequate, Split thickness skin grafts are a safe choice for masking local abnormalities following scalp radiation therapy.…”

Recurrent cutaneous squamous cell carcinoma treated with resection, skin flap, and post-operative radiotherapy: a case report

“…The treatment can be started as early as 3-4 weeks after skin grafting as long as the skin grafts are placed on well-vascularized healthy tissues. Minor skin graft loss due to radiotherapy can usually be treated conservatively 11 .…”