SURGICAL-TREATMENT OF RADIATION INJURIES OF THE HAND

This paper describes the wound management and treatment of 12 consecut ive patients with severe radiation damage to the hands. Three of these were secondary to therapeutic radiation for squamous cell carcinoma i n one and synovial sarcoma in two, and nine were healthy professional people exposed to radiation in the work-place. All lesions were charac teristic radiation burns with ulcerative necrotic changes of the skin and subcutaneous tissues. One patient had a lesion on the dorsum of th e hand, three patients had lesions on the palm of the hand, and eight patients had lesions in the fingers of the hand. Reconstructive surger y was carried out by debridement to what was felt to be healthy margin s, followed by cross-finger flaps or thenar flaps to fingertips in thr ee, radial forearm flaps in three, free flaps from the first web space in three, neurovascular island flaps from the fourth finger in two, a free scapular flap in one, a free inguinal flap with vascularized ili ac crest in one, and a wraparound flap from the great toe in one. Two patients required two procedures; thus 14 flaps were done in 12 patien ts. Follow-up ranged from 2 to 12 months, with a mean of 6 months. All the patients have maintained a healed wound with adequate hand functi on, except for one patient, who had a recurrent synovial sarcoma in th e midportion of the hand, requiring amputation. We conclude that manag ement of radiation-induced injuries to the hand should be done with ag gressive debridement and immediate coverage with well-vascularized fla ps, either regional or free-tissue transfers. This will result in adeq uate wound healing and the most rapid, effective return of function wi th rapid institution of therapeutic modalities.