Muscle flaps in irradiated wounds: an account of 100 consecutive cases

Radiation-related wounds challenge surgeons in all disciplines of surgery. Wound-healing complications are commonplace, and solutions for reconstruction are limited. Muscle and musculocutaneous flaps have improved this situation. We ask the question, Does previous radiation of the muscle to be transposed affect the outcome? One hundred consecutive previously irradiated wounds closed with muscle or musculocutaneous flaps composed the group under consideration. These 100 patients had 151 muscles transposed. The overall complication rate for muscle transposition to close a radiated wound was 25 percent. Of the 100 patients who 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 entire muscle died, requiring total removal and a second tissue transposition from a nonirradiated source to achieve closure. The subgroup using nonirradiated muscle had a complication rate of 19.3 percent; no patient 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 muscle is the best choice for closure of a radiated wound, if possible.