Postoperative radiation of open head and neck wounds--updated

Postoperative radiotherapy is commonly used in treating head and neck cancer. A concern is the possibility of an unhealed surgical wound delaying or disrupting the treatment schedule. Our institution previously reported our experience on the outcome of radiotherapy on unhealed wounds from 1977 to 1984.

In an effort to update and enlarge this series, we reviewed the charts of patients receiving postoperative radiotherapy from 1985 to 1990. Of 267 patients, 20 had unhealed wounds or fistulas at the beginning of treatment. The wounds healed spontaneously in 17 of these patients, 1 required surgical closure, and 2 never healed. Combining our current and previous series, 452 patients had onset of postoperative radiation therapy at our institution from 1977 through 1990, of whom 33 had unhealed wounds at the onset of irradiation.

In 22 of 33 (67%) patients, the wounds healed spontaneously (mean: 98 days, range: 36 to 304 days). Five additional patients achieved successful wound healing following surgical closure (mean: 281 days, range; 112 to 608 days). The remaining 6 patients died before healing was complete (4 patients) or were lost to follow-up (2 patients) at 16 and 27 months before wound healing occurred. Nine patients in this study are alive with no evidence of disease, 19 died of cancer, and 5 died of other causes.

When there are indications to deliver irradiation in the postoperative setting, it is desirable to initiate treatment within 6 weeks of the data of surgery. Although it is preferable to have completely closed operative wounds prior to irradiation, some consideration must be given to initiating irradiation in the face of incompletely closed wounds when it is anticipated that healing time will be prolonged. In some patients, the wounds continue to heal during the course of irradiation, or will stabilize, and can be surgically managed after irradiation is completed or may spontaneously heal after treatment. Excessive delays in initiating appropriate cancer therapy may lead to recurrence prior to irradiation; such recurrences are rarely successfully salvaged.