Pg. Arnold et al., MUSCLE FLAPS IN IRRADIATED WOUNDS - AN ACCOUNT OF 100 CONSECUTIVE CASES, Plastic and reconstructive surgery, 93(2), 1994, pp. 324-327
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.