Introduction:
Radiation therapy is used in the treatment of cancer, but it can cause injury to the healthy tissues surrounding the cancerous cells. There are various types of radiation injury, and the severity of the injury depends on factors like radiation dose, the volume of tissue that is exposed to radiation, the type of radiation, and the fractionation schedule. Injury from radiation can cause different symptoms like fibrosis, impaired wound healing, inflammation, and tissue necrosis. It can be delayed or acute, and it affects the quality of life. In very severe cases, it can even lead to loss of tissue or functional impairment.
Surgical reconstruction can help in restoring the appearance and function of the injured tissues. But this surgical reconstruction is challenging because of the different physiology of tissues, the high risk of infection, and reduced wound healing. The method of surgical reconstruction depends on the extent and location of the radiation injury, the patient's past medical history, and the overall health of the individual. Local tissue flaps, skin grafts, and free tissue transfer are the commonly used surgical techniques for reconstruction in radiation injury.
What Is Surgical Reconstruction of Radiation Injury?
It is a complex process that includes repairing and replacing the damaged or injured tissues and structures in the body, which occurs due to radiation exposure. This type of radiation injury is usually seen in cancer patients who undergo cancer treatment, like radiation therapy. Radiation therapy uses high-energy radiation waves, which help kill cancer cells. Sometimes, radiation therapy can also damage the healthy tissues and cells present in the body. The amount of damage is based on various factors like radiation dose, treatment duration, type of radiation, and the location of the cancer. If the damage due to radiation is very severe, surgical reconstruction is necessary, which helps in restoring the appearance and function of the affected region.
Surgical reconstruction aims to restore the injured region to pre-radiated condition. If the radiation exposure has caused damage to the skin, then plastic surgery is an option. Skin flaps or skin grafts are used to repair the injured area. If the radiation exposure has caused damage to internal organs, procedures to remove and replace the affected structures or tissues are included. Surgical reconstruction is not indicated in every case. If the injury is extensive and spreads to different parts, and when it affects many critical structures like the brain or spinal cord, reconstructive surgeries are contraindicated. In such cases, medications or physical therapies are used to reduce the symptoms and improve the quality of life.
What Are the Different Types of Surgical Reconstruction Done in Radiation Injury?
The surgical method is selected based on the extent and location of the injury. It also depends on the past medical history and health of the patient. In a few cases, a combination of certain surgical methods is used to improve the outcome. The different types of surgical reconstruction methods that are used in radiation injury include the following:
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Skin Graft - Skin graft involves transplantation of healthy skin from a healthy site to the affected area which is injured due to radiation. It helps in covering a small area or wounds of lost skin.
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Local Tissue Flaps -This method uses nearby healthy tissue to the affected area of radiation, which helps in reconstruction. The local tissue is moved to the injured area with the blood supply, which helps in increasing wound healing and also helps in improving functions.
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Free Tissue Transfer - In free tissue transfer, healthy tissue is transplanted from another part of the body to the injured or affected area. That issue is usually detached from the blood supply and is connected to the blood vessels present in the affected or injured area with the help of microsurgery techniques. This type of reconstruction technique is used in larger or more complex reconstructions.
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Fat Grafting - Fat grafting techniques include the transplantation of fat cells to the injured or affected area, which helps in restoring the volume of that particular area. It helps in improving the appearance of a particular area or tissue.
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Expanding Tissues - In this procedure, a balloon-like device is inserted under or near the damaged skin or region. As with time, this balloon-like device will be filled with a saline solution which helps in stretching the tissues and skin. After the expansion, this device is removed. This expanded tissue helps in the repair of the damaged or injured region.
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Bone Graft - A piece of healthy bone is taken from another part of the body and is transplanted into the injured or damaged area. The bone graft can be taken from the patient’s body or can also be taken from a donor. This bone graft technique is usually done in the area of radiation injuries like the spine or jaw.
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Implants - Prosthetic devices or artificial joints are used as implants to replace missing or damaged tissue caused by radiation injury.
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Reconstructive Surgery - In radiation injuries that are very severe, a combination of multiple surgeries is performed to replace or remove the damaged structures or tissues present in the body.
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Microsurgery - Microsurgery is done by using a high-power microscope and specialized instruments which help in the repair of nerves and small blood vessels present in a particular region. This technique is used to reconstruct tissues that are damaged by radiation.
What Is the Prognosis of Surgical Reconstruction in Radiation Injuries?
The surgical reconstruction's prognosis depends on the damage's severity and extent. It also depends on the type of reconstruction and location. Surgical reconstruction helps in reducing pain and discomfort and improves the function and appearance of the injured region. Sometimes complete restoration of the injured region is not possible, but it helps improve the patient's well-being and quality of life. Some complications can also occur during the surgery, like bleeding, infection, or reduced wound healing, affecting the procedure's success. Patients should also have realistic expectations about the surgical reconstruction and discuss the benefits and disadvantages with the healthcare team before the reconstructive procedures.
Conclusion:
In conclusion, radiation treatment is used for cancer patients to kill cancer cells, but in some cases, it can damage or injure adjacent healthy tissues. In such cases, reconstruction is done to restore the appearance and function of the radiation-injured or affected tissue. It is a challenging procedure as there will be various tissue physiology and reduced wound healing. The rest is done by a multidisciplinary approach involving a plastic surgeon, an oncologist, and other specialists. Proper planning and patient selection are needed to get a successful outcome. Surgical reconstruction of radiation-injured areas can help increase the quality of life.
