For years I have been talking about the complications of shin radiation in elderly patients. The patients all underwent radiation for skin cancer having been told that since they were old and had “circulation issues”, radiation was a better option than undergoing a large surgical excision. So far, none of the patients I have seen with radiation tissue damage have had underlying arterial disease (at least, not before they had radiation) and none even had very significant venous disease. In other words, there’s no reason to think they wouldn’t have healed a surgical excision or even a flap, but they had radiation instead – with awful results.
I don’t know if I speak for all wound care practitioners, but give me a huge surgical wound any day over a case of soft tissue radionecrosis — in terms of how long it will take to heal and whether they heal at all! Many of these patients with shin radiation have required plastic surgical flaps to handle the radiation damage, operations that were far more difficult and extensive than the original cancer surgery would have been. That’s why I’ve started the “Stop the madness of shin radiation” campaign. If you have a case like this, feel free to send it to me and I will post it (no patient identifying information please).
This case is from a colleague who prefers to remain anonymous:
This is a 76 year old male with a history of HTN, obesity, and CAD who was sent to me for evaluation of an anterior right shin wound in 2019 due to resection of a squamous cell carcinoma (SCCA). He underwent resection of the area with subsequent brachytherapy and was left with a large wound that failed to heal.
A CT showed no osteomyelitis; an Arterial Doppler showed triphasic waveforms (meaning, good flow), a venous study showed only 1 incompetent perforator that was not clinically relevant. The patient wanted to avoid the commitment of hyperbaric oxygen therapy if possible and healed slowly with a combination of debridements, collagen dressings, and a compression stocking. He healed in 6 months with conservative wound care.