Flap Application in Reconstructive Surgery to Manage Severe Radiation-induced Ulcers

A Case Series

Hoang Thanh Tuan, MD, PhD; Vu Quang Vinh, PhD; Tran Van Anh, PhD; Tong Thanh Hai, MD, MS; Tran Quang Phu, MD, MS; Trinh Tuan Dung, PhD


Wounds. 2023;35(1):E7-E13. 

In This Article

Abstract and Introduction


Introduction: Radiation-induced ulceration is a late-stage skin reaction after RT for cancer treatment.

Objective: The present study examined the use of a single-stage reconstructive procedure to manage radiation-related wounds.

Materials and Methods: Nine patients with radiation-induced chronic ulcer with accompanying severe complications were admitted to the Plastic, Reconstructive, and Regenerative Center of Viet Nam National Burn Hospital between October 2015 and September 2019. The patients ranged in age from 49 to 77 years. Complications included exposed cheekbone (n = 1), exposed trachea (n = 1), exposed carotid artery (n = 2), exposed axillary artery (n = 2), exposed pleura (n = 1), and exposed pericardium (n = 2). Flap type used to achieve defect coverage after debridement was individualized to each patient and included ALT, LD, SCA, and DIEP flaps. Additionally, a high-density polyethylene was used to reconstruct the trachea to recover breathing function in the patient with exposed trachea.

Results: Complete survival of all flaps was achieved. Most vital organs (the trachea, axillary artery, and carotid artery) were covered. Hospital length of stay ranged from 15 to 120 days.

Conclusions: The successful management of patients with severe complications suggests that immediate single-stage reconstruction may be a valuable option for managing radiation-induced ulcers.


RT has a substantial impact on the treatment of cancer. It can cure some cancers in the early stages, and sometimes it is used to alleviate symptoms caused by cancer.[1,2] However, RT-associated early and late side effects may affect various organs, such as the skin and mucosa, salivary glands, nervous system, thorax, lung, and heart.[3] Skin injuries may be considered the most common of these undesired outcomes, with 95% of patients who receive RT sustaining such injuries.[4] While acute radiation damage including mucositis, hypersensitivity, pain, and ulcer can be healed with appropriate management, some late complications, such as fibrosis and nonhealing ulcers, are often irreversible.[4,5] More importantly, some nonhealing deep ulcers sometimes threaten vital organs. Inflammation, ischemia, and secondary wound infections could lead to poor quality of life.[5] In severe cases, wide surgical debridement and reconstructive techniques have often been used to manage these ulcers.[5,6] However, limited reports of complicated RT-induced ulcers in the literature have made it difficult for even the most skilled plastic surgeons to find the best treatment options for these cases.

This case series discusses 9 patients with severe RT-induced ulcers, including ulcer bases containing exposed cheekbone, exposed carotid artery, exposed axillary artery, exposed trachea, exposed pleura, and exposed pericardium. These wound types are not well represented in the literature. Additional treatments and surgical outcomes of these patients are also discussed. This study contributes to the current literature on the management of these rare cases.