Adjuvant RT and Surgical Wounds

[medicineradman]

I have started seeing a number of patients that have scars from their surgical wounds and need adjuvant RT. I don't have a really good way of knowing when the best time to start their treatment it. How do you know when it is really ok to start RT? I had a guy whose wound dehisced after over a month of healing in an area of relatively high tension. Is there any guidance on this. It's a big headache for the patient if they dehisce. Not something I encountered a lot in training. Thank you

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[seper]

I always try to have surgeons explicitly "clear" patients to start XRT.
On occasion (think post-laryngectomy for T4 tumors) you'd have no choice but to start XRT with open areas in the incision.

 

[Chartreuse Wombat]

http://onlinelibrary.wiley.com/doi/...199705)19:3<194::AID-HED5>3.0.CO;2-Y/abstract

 

[medgator]

I always try to have surgeons explicitly "clear" patients to start XRT.
On occasion (think post-laryngectomy for T4 tumors) you'd have no choice but to start XRT with open areas in the incision.

Yup, wait too long and then you find out why the healing was prolonged unfortunately (tumor doesn't let healing occur). Happened to me with a merkel cell, started recurring 2 weeks post-op

 

[seper]

wow, there are data for everything, thanks

 

[Reaganite]

I stressed so much about this out of residency myself! However, I've since been placed in multiple circumstances where I had to radiate essentially open wounds (some malignant and some post op) and have had zero issues. In all cases, wounds healed during the course of xrt. I think we over-stress.