Limits...
Accidental radioisotope burns - Management of late sequelae

Varghese BT, Thomas S, Nair B, Mathew PC, Sebastian P - Indian J Plast Surg (2010)

Bottom Line: He was treated with morphine and NSAIDs, epidural buprinorphine and bupivicaine for pain relief, steroids, antibiotics followed by wound excision and reconstruction with tensor fascia lata(TFL) flap.Patient had breakdown of abdominal scar later and it was excised with 0.5 cm margins up to the underlying muscle and the wound was covered by a latissimis dorsi flap.Further scar break down and recurrent ulcers occurred at different sites including left wrist, left thumb and right heel in the next two years which needed multiple surgical interventions.

Affiliation: Division of Surgical Oncology, Regional Cancer Centre, Trivandrum, India.

ABSTRACT

Accidental radioisotope burns are rare. The major components of radiation injury are burns, interstitial pneumonitis, acute bone marrow suppression, acute renal failure and adult respiratory distress syndrome. Radiation burns, though localized in distribution, have systemic effects, and can be extremely difficult to heal, even after multiple surgeries. In a 25 year old male who sustained such trauma by accidental industrial exposure to Iridium192 the early presentation involved recurrent haematemesis, pancytopenia and bone marrow suppression. After three weeks he developed burns in contact areas in the left hand, left side of the chest, abdomen and right inguinal region. All except the inguinal wound healed spontaneously but the former became a non-healing ulcer. Pancytopenia and bone marrow depression followed. He was treated with morphine and NSAIDs, epidural buprinorphine and bupivicaine for pain relief, steroids, antibiotics followed by wound excision and reconstruction with tensor fascia lata(TFL) flap. Patient had breakdown of abdominal scar later and it was excised with 0.5 cm margins up to the underlying muscle and the wound was covered by a latissimis dorsi flap. Further scar break down and recurrent ulcers occurred at different sites including left wrist, left thumb and right heel in the next two years which needed multiple surgical interventions.

Ulcer measuring 5 × 5 cm in the right groin
© Copyright Policy

Figure 0001: Ulcer measuring 5 × 5 cm in the right groin

Mentions: A 25-year-old male, who sustained accidental industrial exposure to Iridium192 while repairing a gamma camera at his work place in Bahrain in March 2000, presented with a non-healing painful ulcer of size 5×5 cm over the right groin to our centre in October 2000 [Figure 1]. Further enquiry revealed that, immediately after exposure he developed recurrent attacks of hemetemesis requiring supportive treatment in a local hospital. Three weeks after the exposure he developed burns at the contact areas, which included the left hand, left side of the chest, abdomen and right inguinal region. All except the inguinal burn healed with unstable scars. At the fourth week he developed severe bone marrow depression with a platelet count of 61 × 109/liters and a WBC count of 2.5 × 109/liters, which also recovered with supportive treatment at the local hospital.

View Similar Images In: Results  - Collection
View Article: Pubmed Central -  PubMed
Show All Figures - Show MeSH
getmorefigures.php?pmc=3038384&rFormat=json&query=null&req=5
Accidental radioisotope burns - Management of late sequelae

Varghese BT, Thomas S, Nair B, Mathew PC, Sebastian P - Indian J Plast Surg (2010)

Ulcer measuring 5 × 5 cm in the right groin
© Copyright Policy
Figure 0001: Ulcer measuring 5 × 5 cm in the right groin
Mentions: A 25-year-old male, who sustained accidental industrial exposure to Iridium192 while repairing a gamma camera at his work place in Bahrain in March 2000, presented with a non-healing painful ulcer of size 5×5 cm over the right groin to our centre in October 2000 [Figure 1]. Further enquiry revealed that, immediately after exposure he developed recurrent attacks of hemetemesis requiring supportive treatment in a local hospital. Three weeks after the exposure he developed burns at the contact areas, which included the left hand, left side of the chest, abdomen and right inguinal region. All except the inguinal burn healed with unstable scars. At the fourth week he developed severe bone marrow depression with a platelet count of 61 × 109/liters and a WBC count of 2.5 × 109/liters, which also recovered with supportive treatment at the local hospital.

Bottom Line: He was treated with morphine and NSAIDs, epidural buprinorphine and bupivicaine for pain relief, steroids, antibiotics followed by wound excision and reconstruction with tensor fascia lata(TFL) flap.Patient had breakdown of abdominal scar later and it was excised with 0.5 cm margins up to the underlying muscle and the wound was covered by a latissimis dorsi flap.Further scar break down and recurrent ulcers occurred at different sites including left wrist, left thumb and right heel in the next two years which needed multiple surgical interventions.

Affiliation: Division of Surgical Oncology, Regional Cancer Centre, Trivandrum, India.

ABSTRACT

Background: Accidental radioisotope burns are rare. The major components of radiation injury are burns, interstitial pneumonitis, acute bone marrow suppression, acute renal failure and adult respiratory distress syndrome. Radiation burns, though localized in distribution, have systemic effects, and can be extremely difficult to heal, even after multiple surgeries. In a 25 year old male who sustained such trauma by accidental industrial exposure to Iridium192 the early presentation involved recurrent haematemesis, pancytopenia and bone marrow suppression. After three weeks he developed burns in contact areas in the left hand, left side of the chest, abdomen and right inguinal region. All except the inguinal wound healed spontaneously but the former became a non-healing ulcer. Pancytopenia and bone marrow depression followed. He was treated with morphine and NSAIDs, epidural buprinorphine and bupivicaine for pain relief, steroids, antibiotics followed by wound excision and reconstruction with tensor fascia lata(TFL) flap. Patient had breakdown of abdominal scar later and it was excised with 0.5 cm margins up to the underlying muscle and the wound was covered by a latissimis dorsi flap. Further scar break down and recurrent ulcers occurred at different sites including left wrist, left thumb and right heel in the next two years which needed multiple surgical interventions.

View Similar Images In: Results  - Collection
View Article: Pubmed Central -  PubMed
Show All Figures - Show MeSH
getmorefigures.php?pmc=3038384&rFormat=json&query=null&req=5