Addressing challenges in treating fluoroscopy-associated dermatitis: a case series

Radiation exposure in patients has become increasingly common in diagnostic and therapeutic procedures guided by fluoroscopy. Radiation ulcers are one of the most serious consequences of radiation therapy, especially when the cumulative radiation dose is very high. Under such circumstances, patients may experience severe pain and permanent disfigurement due to tissue destruction. This article addresses the challenges faced by the authors in managing and treating fluoroscopy-associated radiodermatitis wounds.

This was a prospective case series involving patients with radiation ulcers (grade 4 radiodermatitis) induced by fluoroscopy. The treatment involved debridement of devitalised tissue, wound bed preparation and reconstruction using local or regional flaps. The assessment of wound pain was performed before surgical treatment and six months after, using a Visual Analogue Scale.

The ages of the three patients included in this case series ranged from 42-71 years. Wound reconstruction was carried out with bilobed flap, V-Y advancement flap, and latissimus dorsi flap. The mean follow-up was 10 months (range: 6-12 months); during this period all patients presented with a significant improvement in pain. There was no recurrence of any wound during the follow-up period. Conclusion: Management of radiodermatitis induced by fluoroscopy is challenging and plastic surgeons play an important role in the treatment of radiation ulcers. Surgical treatment of these wounds should include debridement and resectioning of the entire lesion, followed by reconstruction with flaps. As pain related to the ulcer may be improved or relieved after surgery, surgical treatment should be considered in these situations.