Radiation Necrosis: Complex Wound Closure Utilizing a Team Approach

50-year-old female admitted to the hospital with a wound to her right buttocks which was very painful, measuring 9cm X 7cm, covered with slough and indurated around the edges extending to the left buttocks. Diagnosed with 3b cervical cancer 10 months ago the patient received external and internal radiation. Treatment was completed 7 months prior to this admission.

The patient was started on IV Vancomycin and Zosyn per Infectious Disease. Wound and blood cultures were negative. ½ strength betadine dressing changes were initiated BID. The wound worsened, getting larger and more indurated. The dressing was changed to a daily enzymatic debriding agent on day 5 of hospitalization. Concerned for squamous cell carcinoma a punch biopsy was completed on day 7 of admission, which was negative. A CT scan showed no abscess. Dermatology was consulted 12 days after admission. Suspicious of Sweet Syndrome the patient was started on Prednisone and dressings were changed to a silver antimicrobial daily. After one dose of Prednisone the pain was significantly improved. The patient was discharged after 15 days in the hospital.

The patient followed up at the outpatient wound center. She received 30 hyperbaric treatments for soft tissue radiation necrosis. Many advanced wound care treatments were performed such as ½ strength betadine, medical grade honey, vacuum assisted closure device, and medical maggots. She received multiple high potency antibiotics, off loaded the area well, and took an oral nutritional supplement. Plastic surgery was consulted who requested 20 more hyperbaric treatments prior to surgery. Finally, an extensive flap surgery was performed. A small portion of the flap became necrotic which the patient is still seeking treatment for.

In conclusion this case demonstrates multidisciplinary input for one complex wound.