BIOLOGICAL-ACTIVITY OF TISSUE FLAPS IN THE TREATMENT OF COMPLICATED IRRADIATION WOUNDS

Within the last ten years, 79 patients were treated for 114 chronicall y contaminated, intractable irradiation wounds using various methods o f the modern plastic surgery. Radical excision of the devitalised cont aminated tissue has been impracticable in 25 cases due to the risk of life-threatening complications or significant functional loss. Differe nt types of flaps such as cutaneous, fasciocutaneous, musculocutaneous , split muscle, isolated vascularised fascia and greater omentum have been used. Despite the incomplete excision, 84% of wounds healed prima rily. The essential factor for good wound healing seems to be the ''bi ologic activity'' (BA) of the flap's deep tissue layer that directly c ontacts the wound bed. BA includes density of the vascular net, abilit y of neovascularisation, plasticity and specific immunological capacit ies. It seems to be possible to classify the flaps according to the BA level. Tissue defects in which the chances for radical debridement ar e poor need the highest BA level in the flap reconstruction.