Dr Dylan Prunster¹, Dr Peter Meier¹, Mr Jeremy Rawlins^1,2

¹Fiona Stanley Hospital – State Burns Service of Western Australia , Perth, Australia, ²President of the Australia & New Zealand Burns Association

Abstract:

Introduction

The use of fluoroscopic guidance for interventional radiological procedures (IR) has significantly increased in recent years. The reduced need for invasive surgery, cost effectiveness and reduced length of stay are all significant benefits. Radiation induced dermatitis or thermal burn injury are relatively uncommon side effects with the incidence being reported to vary from 0.0001-2% (Allen et al, 2009). Cutaneous injury can range from transient ischaemia to skin necrosis and ulceration and is directly related to dose of radiation exposure. The difficultly in diagnosing these injuries is that they many only manifest weeks to months post radiation exposure (Allen, 2009; Valentin, 2000).

Objectives

We present an unusual case of radiation burn secondary to a complicated percutaneous ablation of a splenic artery aneurysm resulting in a delayed radiation burn requiring reconstruction

Methods

A 57-year gentleman was referred for review of a 10x15cm chronic lower back wound (figure 1), which initially developed as a rectangular area of mixed depth cutaneous dermal loss, although initially conservatively managed with dressings, the wound further deteriorated and remained unhealed despite multiple surgical debridement’s and NPWT in rural hospital. After further investigation it was revealed that the burn resulted from a complex fluoroscopic interventional radiological splenic artery embolization, the dose of radiation received was unclear but in excess of 10Gy.  The wound was temporized and later reconstructed with a regional flap (figure 2).

Conclusion

Interventional radiology procedures have significantly reduced the need for invasive surgical intervention are cost effective in treating many pathologies. Although generally well tolerated with well minimal side-effect profiles, care must be taken to reduce radiation dose and interventional radiologists must be cognizant to the potential for radiation induced burns and refer early to specialist burns care with any suspicion of cutaneous injury (Archer, 2002).

References

Allen B, Cuzzone D, Rowin C, Perdrizet G, Babigian A. Fluoroscopic radiation burn after embolization of a spinal arteriovenous malformation. J Burn Care Res. 2009 Mar-Apr;30(2):349-51

Valentin J. Avoidance of radiation injuries from medical interventional procedures. Ann ICRP. 2000;30(2):7-67.

Archer BR. High-dose fluoroscopy: the administrator’s responsibilities. Radiol Manage. 2002 Mar-Apr;24(2):26-32;

Biography:

Dr. Dylan Prunster is a surgical service registrar working within the West Australian Health Department with a keen interest in Plastic and Reconstructive Surgery. He obtained his primary medical qualification from the University of Western Australia and subsequently undertook an internship and residency at Royal Perth Hospital.