Elsevier

JPRAS Open

Original Commodity

Dumb wound healing afterward radiation therapy: A systematic review of pathogenesis and treatment

Under a Creative Commons license

Open up access

Abstract

Background

Radiotherapy is a mutual cancer treatment, but often results in unintended injury to overlying skin and contributes to poor wound healing. The mechanisms underlying these changes are complex, and existing treatment is express. Nosotros aimed to systematically review the literature on the pathogenesis, management, and experimental treatment of delayed wound healing post-obit radiations therapy.

Written report Design/Methods

A literature search was performed following PRISMA-P guidelines. PubMed and the Cochrane Library were queried for full-text English language articles published up to 2022 past using cardinal search terms including "radiotherapy" and "wound healing." Additional resources were retrieved from reference lists. The selected manufactures discussed mechanisms of pathogenesis, current management, and experimental treatment of radiation-induced skin injury. These are reported every bit a qualitative synthesis of the literature from the authors' perspective.

Results

The literature search yielded 442 articles, of which 93 were included in this review. Ionizing radiation causes DNA damage by direct strand breaks and oxygen-derived free radicals. This insult results in cellular alterations that underlie mechanisms of delayed wound healing. Prominent theories underlying pathogenesis include cellular depletion, stromal jail cell dysfunction, aberrant collagen deposition, and microvascular damage. Pro-inflammatory cytokines and complimentary radical cascades contribute to chronic radiation damage, with transforming growth cistron beta-ane (TGF-β1) implicated as a key player in the process of fibrosis. Now, radiation injury is managed medically with conventional wound intendance with minimal success and limited evidence-based data. Surgical direction with local or free flap transfer is often compromised past poor surrounding tissue and recipient vasculature. Experimental treatment models are emerging that target mechanisms of pathogenesis. These modalities include stem cell repletion, antioxidant therapy, TGF-β1 modulation, and implantable biomaterials.

Decision

Pathogenesis of delayed wound healing and fibrosis post-obit radiotherapy is a complex, interdependent procedure involving cellular depletion, extracellular matrix changes, microvascular damage, and altered pro-inflammatory mediators. Current treatment is limited, and more Level I studies are needed to develop best-practice recommendations. Investigatory treatment options targeting specific mechanisms of injury may offer potential solutions to this significant clinical and surgical problem.

Keywords

Skin

Ionizing radiation

Wound healing

Radiation fibrosis

Radiations therapy

Systematic review

© 2022 The Author(southward). Published by Elsevier Ltd on behalf of British Association of Plastic, Reconstructive and Artful Surgeons.