Surgical problems in the excision and repair of radiated tissue

Surgical procedures for tissues damaged by radiation are fraught with the possibility of multiple and serious complications. A knowledge of the altered pathophysiology of such tissues (chiefly diminished blood supply, fibrosis, and direct cellular reparative potential) is necessary for the surgeon to make a proper judgment. Recognition of the pathognomic signs in the skin is important. The possibility of malignant change must be kept in mind. Surgical treatment must include the excision of radiated tissues back to good blood supply, and then proper and adequate coverage by the simplest and best means. If the surrounding local tissues are so altered that they are unsuitable for coverage, structures from a distance must be used. Prior planning of the coverage before the excision pays dividends by preventing disastrous complications.