MUSCLE FLAPS IN IRRADIATED WOUNDS - AN ACCOUNT OF 100 CONSECUTIVE CASES

Radiation-related wounds challenge surgeons in all disciplines of surg ery. Wound-healing complications are commonplace, and solutions for re construction are limited. Muscle and musculocutaneous flaps have impro ved this situation. We ask the question, Does previous radiation of th e muscle to be transposed affect the outcome? One hundred consecutive previously irradiated wounds closed with muscle or musculocutaneous fl aps composed the group under consideration. These 100 patients had 151 muscles transposed. The overall complication rate for muscle transpos ition to close a radiated wound was 25 percent. Of the 100 patients wh o received radiation, 43 patients had the muscle transposed for wound closure from the primary field of radiation. Fifty-seven patients were closed with nonirradiated muscle. When the transposed muscle had been radiated, the complication rate was 32 percent; in 14 percent, the en tire muscle died, requiring total removal and a second tissue transpos ition from a nonirradiated source to achieve closure. The subgroup usi ng nonirradiated muscle had a complication rate of 19.3 percent; no pa tient in this group had complete flap death requiring a second tissue transposition. Two postoperative deaths, one in each group, unrelated to the operative procedure were recorded. We feel that nonirradiated m uscle is the best choice for closure of a radiated wound, if possible.