The Burns Surgeon and Chronic Radiation Dermatitis: Hither and Yon Without any Rhyme or Reason
James Jeng1, 1University Of California Irvine, Orange, California, United States of America
Abstract
Introduction:
A gentleman of means recently came under our care at the University of California Irvine Burn & Wounds Centre; he suffered from chronic radiation dermatitis with a draining open wound of the thigh (after adjuvant radiotherapy for sarcoma). Although successfully healed after a great while, we were all frustrated with the dearth of actionable knowledge concerning best practices. His grateful largess included a generous contribution to our centre, with the pointed objective of underscoring this unmet need to the burns community.
Methods:
An exhaustive search was done of both scholarly databases and the lay “electronic” press with search terms: “chronic radiation dermatitis”, and sensible variations thereof.
Results:
The vast majority of entries found in the academic forums focused on acute radiation dermatitis, with almost no substantive discussion of chronic radiation dermatitis and its complications (51 total citations in the National Library of Medicine database). There were no systematic reviews. In the consumer-oriented forums, there is to be found a true potpourri of scattered and disparate advice, even from the more recognized tertiary care medical center webpages. Just as varied were the professional communities that took an interest: radiation therapists, dermatologists, oncologists, but notably NOT the plastic surgery nor burns communities.
Conclusion:
Radiation dermatitis occurs in over 90% of patients receiving adjuvant radiotherapy (tens of thousands of patients), with an unknown fraction going on to develop chronic skin and wound problems. We are very likely dealing with an under-recognized and underreported orphan disease. More alarming is the silence of the plastic surgery and burns community–those most likely to be caring for the worst clinical cases. Rather than continuing to grope forward blindly, those most responsible for complex wound care must lead the charge to enact multidisciplinary consensus efforts to tame this beast.
Biography
Seasoned academic burns surgeon with keen scholarly interests in mass casualty preparedness and wound care. Actively practicing (predominantly) burns, wound care, surgical critical care, acute care surgery, and trauma care in the LA Basin.