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Clinical Manifestation, Diagnosis, and Surgical Treatment of Chronic Radiation Ulcers Related to Percutaneous Coronary Intervention

Lee, Biing Luen MD; Ma, Hsu PhD; Perng, Chern Kang; Wang, Tien Hsiang; Liao, Wen Chieh; Yeh, Fa Lai; Shih, Yu-Chung MD

doi: 10.1097/SAP.0000000000000688
Clinical Papers

Chronic radiation ulcers that develop after cardiac catheterization have become common recently because of the rapid increase in the use of diagnostic and interventional cardiac catheterization procedures. However, their diagnosis and treatment remain difficult. We encountered 10 patients with National Cancer Institute grade 4 radiation ulcers related to prolonged percutaneous coronary intervention. Data of these 10 patients, including clinical presentations and treatments, were collected and analyzed. A quality-of-life questionnaire was administered to the patients preoperatively and postoperatively. Most of the lesions (8/10 patients) were located on the back. All of the patients received prolonged cardiac catheterization lasting for more than 3 hours, at least once, and all of the coronary artery lesions showed chronic total or near-total occlusion. The surgical procedures included complete resection of the lesion followed by fasciocutaneous flap coverage (9/10) or skin grafting (1/10). The mean ± SD follow-up time was 23.3 ± 19.79 months, and the wounds in all the patients healed well without complications. After the surgery, the symptoms reduced and the quality of life improved significantly according to the scores in the quality-of-life questionnaire. In conclusion, the early diagnosis of chronic ulcers related to prolonged percutaneous coronary intervention depends on careful history taking and a highly suspicious clinical presentation. For National Cancer Institute grade 4 radiation ulcers, complete resection and immediate reconstruction with flaps or grafts may improve the symptoms and achieve reliable wound coverage without complications.

From the *Taipei Veterans General Hospital; and †Institute of Clinical Medicine, National Yang-Ming University, Taipei, Taiwan.

Received October 14, 2015, and accepted for publication, after revision October 27, 2015.

Conflicts of interest and sources of funding: none declared.

This study was presented at the 2015 Annual Meeting of the American Society of Plastic Surgeons, on October 18, 2015, at the Boston Convention and Exhibition Center, USA. The abstract had been published in Plast Reconstr Surg. 2015 Oct;136(4 suppl):123–124.)

Reprints: Yu-Chung Shih, MD, Taipei Veterans General Hospital Taipei, Taiwan. E-mail:

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