Surgical treatment of radiation injuries of the hand

This paper describes the wound management and treatment of 12 consecutive patients with severe radiation damage to the hands. Three of these were secondary to therapeutic radiation for squamous cell carcinoma in one and synovial sarcoma in two, and nine were healthy professional people exposed to radiation in the work-place. All lesions were characteristic radiation burns with ulcerative necrotic changes of the skin and subcutaneous tissues. One patient had a lesion on the dorsum of the hand, three patients had lesions on the palm of the hand, and eight patients had lesions in the fingers of the hand. Reconstructive surgery was carried out by debridement to what was felt to be healthy margins, followed by cross-finger flaps or thenar flaps to fingertips in three, 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 iliac 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 patients. 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 function, except for one patient, who had a recurrent synovial sarcoma in the midportion of the hand, requiring amputation. We conclude that management of radiation-induced injuries to the hand should be done with aggressive debridement and immediate coverage with well-vascularized flaps, either regional or free-tissue transfers. This will result in adequate wound healing and the most rapid, effective return of function with rapid institution of therapeutic modalities.