Medical and surgical management for localized radiation injuries

Whereas the pathological effects of radiation to the skin are well known, it is often difficult to assess quickly and with accuracy the level of severity, because of the delay between exposure and appearance of the lesions and because of the hidden lesions in underlying tissues. The severity depends mainly on the nature of the radiation, high-energy penetrating radiation causing much more irreversible damage than low-energy lightly penetrating radiation. Therefore, besides the clinical observation, diagnosis and prognosis should be based on many various parameters such as dosimetry, reconstruction of the accident, thermography, scintigraphy, etc. Pain is the first difficult problem to solve. It starts quickly, is constant at all stages and rapidly dominates the clinical picture. It raises the problem of the use of toxic drugs, with the risk of addiction. Medical treatment deals with inflammation, moist desquamation and ulceration. The major problem is the risk of infection. Surgical treatment deals with deep ulceration and necrosis; the requirement varies, according to the nature and energy of the radiation, the localization of the injury and its severity. The two main methods are excision and grafting; the most favourable time for intervention is difficult to specify, and should be neither too early before the establishment of the clinical picture nor too late. The combination of radiation burns with an acute radiation syndrome raises many questions, many of which are not completely solved.