From “ANNALS OF SURGERY” VOL. 162 No. 3 p. 435 September 1965
HIGH ENERGY ELECTRON INJURY
(cont.) …”It was not done because her arm was not swollen, and it was thought that manipulation around the axilla in getting a flap in place might result in a less favorable circulation in the arm. This equivocal point had been brought about because in an earlier attempt at restoration (elsewhere) a flap did not survive. This left still more scar around the area, precluding the use of the most likely pedicle for a flap. The patient had been operated upon and treated by radioactive cobalt and is still free of cancer after 10 years. Such losses and such efforts to get them repaired are worthwhile if otherwise fatal cancer has been controlled as in this patient.
The patient in Figure 10 has a still wider-spread radiation burn occurring on both sides of the neck and down onto the adjacent thorax. This patient has not developed slough but has the typical chronic burn. She is shown following complete excision of the area in three stages and substitution of the thick split grafts without the need of a flap.
It is true, in all radiation burns, that free skin grafts may suffice if they can find enough blood supply to “take.” They are usually serviceable, give the best results and are the least troublesome for the patient. There is no reason to believe, however, that a free graft will work if a thicker supply is needed to protect the defect, and it is usually thought that an exposed point of maximum impulse of the heart, or pericardium, or pleura or lung would need a flap coverage.
An important point is that these can be done in stages and do not have to have a complete flap repaid immediately. If on the other hand, for exposed or open pericardium or pleura and immediate flap can be done, it can be put in place in a single or double-stage procedure.
Aloe Vera gel for chronic radiation burns is worthwhile, with a tendency for the Aloe Vera to check keratosic development if it is started early. This is an old treatment we have used, borrowing the Aloe Vera leaves from the Missouri Botanical Garden (Shaw’s Garden) and putting the fresh leaf gel on the wound. Now the Aloe Vera gel can be obtained as Aloe Cream Ointment *** with 55 percent gel in it, and it can be used with advantage on all radiation lesions, with the qualification that if sensitivity occurs it can be discontinued. There are instances of physicians’ hands that have been cared for with Alo Ointment or with the pure fresh gel; widespread resection and operation thus have been avoided, although it is not certain that this advantage will last throughout their lives. At least there is indication that the Aloe Vera gel may bring about a reversal of the keratosic tendency of typical chronic radiation burns if started early and continued.
A summary of radiation lesions of the chest and neck is the same as in any area of the body – that they will probably need to be resected and repaired either with free grafts or with flaps. The lesions on the chest have the added difficulty of the possible exposure of pleura pericardium lung or the heart. In these instances a flap is nearly always indicated and it can be the most direct type of flap which is a short, broad, blood-carrying flap with a permanent pedicle that is not interrupted after the flap has grown in place.
Pain can be excessive in radiation injuries but usually as soon as the patient is awake he will make it known that the pain is gone, although he may be having new pain from the operation. At least the deep, boring pain is relieved by the resection. It is best if the defect can be covered by an immediate graft or flap but, as noted, these procedures may be done in stages with the wounds left open temporarily.
Diagnosis becomes particularly important when there is delay. There is some”…
*** Aloe Creme Laboratories, Fort Lauderdale, Florida
James Barrett Brown, M.D., F.A.C.S.
Compliments of Aloe #1 Laboratories 750 NW 38th Street Oakland Park, FL 33309