Treatment for Stalled Radiation Head Wound

William Pace, MD
Jefferson Frankford and Jefferson Bucks Hospitals, Philadelphia

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Patient Presentation

  • In January 2020, a 77-year-old male presented with a large (11cm x 14cm) radiation wound at top of his head after finishing radiation therapy in December 2019.
  • Wound had been open for 1 month, and patient was in constant and severe pain.
  • Wound was especially sensitive to touch, and no pain treatment was effective.
  • Dressing changes took 45 minutes to an hour and involved multiple clinicians taking turns to slowly remove the dressing.
  • Patient had difficulty sleeping.

Failed Therapy

  • ADAPTIC TOUCH™
  • Mepitel®
  • Xeroform™

Procedure & Treatment

  • Scalp was irradiated and debrided for second intention healing.
  • Microlyte® Matrix was then tiled over the entire surface of wound, then covered with ADAPTIC TOUCH™
  • Microlyte and ADAPTIC TOUCH™ were reapplied on day 3.
  • Patient was then assessed on day 4, day 14, then weekly until week 16.

Clinical Outcome

  • After just 4 days of Microlyte® treatment, the patient’s wound decreased from 11cm x 14cm to 8.5cm x 10.5cm, a 42% reduction.
  • Patient reported slight pain at dressing removal, and no pain at all during and after Microlyte® application.
  • Patient was able to sleep for the first time in months.
  • Importantly, the wound did not become infected.
  • On day 14, wound tissue showed increased granulation and decreased exudate.
  • At 16 weeks, the wound decreased to 3.5 cm x 4 cm, a 91% reduction from day 1.

Conclusion

  • Post-irradiated tissue over a large surface area is notoriously difficult to treat and is prone to infection.
  • Radiation wounds often turn into chronic ulcers, because of difficulty containing radiation treatment to malignant cells without damaging surrounding healthy cells.
  • In this case study, we demonstrate that Microlyte® was able to close a large radiation wound by 42% in 4 days after previous treatment failed to close patient’s wound.
  • In addition to efficacy, Microlyte® use was painless and allowed the patient to sleep, thereby increasing his quality of life.
  • Microlyte® and ADAPTIC TOUCH™ worked together to jump-start patient’s wound-healing process and shows promise in treating difficult-to-treat radiation chronic ulcers.

(A) DAY 1

(B) DAY 1

(C) DAY 4

(D) DAY 14

(E) Week 16

Figure 1: Patient presented with an excised scalp wound that was irradiated and debrided for second intention (A). Microlyte® was applied over the entire surface of wound (B), and then reapplied on the 3rd day (figure not shown). Wound closed 42% over 4 days (C) and demonstrated new granulation tissue and decreased exudate on day 14 (D). At 16 weeks, the wound decreased to 3.5 cm x 4 cm, A 91% reduction from day 1 (E).

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