Therapy in Fluoroscopy-Assisted Cardiac Interventional Procedure Induced Chronic Radiation Dermatitis-Case Series in An Institutional Experience

X光輔助心臟動脈導管治療導致嚴重慢性放射性皮膚潰瘍的治療經驗－高雄榮民總醫院的經驗

楊佩容(Pei-Jung Yang) ； 劉文忠(Wen-Chung Liu) ； 陳理維(Lee-Wei Chen) ； 林政達(Cheng-Ta Lin) ； 何彥儀(Yen-Yi Ho) ； 楊國強(Kuo-Chung Yang)

《臺灣整形外科醫學會雜誌》 24卷4期 (2015/12) Pp. 289-296

摘要

背景：隨著X光輔助心臟動脈導管治療技術以及相關置入裝置的進步，使得過去嚴重心血管阻塞患者改採用此低侵襲性處置的比例大幅增加。致使反覆或長時間的心導管及心臟電氣灼燒術而導致嚴重慢性放射性皮膚炎的患者，在這數年間已逐漸成為一部份整形外科門診求診的特殊族群。目前尚無關於此類嚴重皮膚併發症的治療探討。目的及目標：本篇文章的目的在於提供本院關於X光輔助心臟動脈導管治療導致嚴重慢性放射性皮膚炎的治療經驗分享。材料及方法：回溯性收集本院自2012年八月至2015年五月間診斷為嚴重慢性放射線皮膚潰瘍並接受手術治療患者的資料。詳述治療方式與其結果。結果：在過去本院共有11位病患診斷為嚴重慢性放射線皮膚潰瘍並接受手術治療。在前四位患者多次清創的治療經驗中發現，根除式切除範圍須包含皮膚壞死潰瘍以及毛細管擴張區域，切除深度需含括肌肉筋膜，才能達到傷口最佳癒合能力。因患者在多次清創手術間抱怨劇烈難耐的傷口疼痛，再加上第四位患者治療過程中發生急性冠心症而無法施以傷口閉合手術，因此後續7位患者改採用一次性根除式切除併傷口閉合手術，疼痛與麻醉風險均降至最低。傷口癒合狀態均良好。唯第五位患者術後曾撞裂部分傷口引發感染，經清創與傷口照護後復原良好。另所有病患都完成20次高壓氧療程。結 論：根據本院現有資料結果，一次性根除式切除併立即傷口閉合手術對於嚴重慢性放射線皮膚炎患者來說，是合宜的治療選擇。

並列摘要

Background: Increasing number of patients with extreme cardiac disease underwent minimalinvasive fluoroscopy-assisted cardiac intervention, which raised the ratio of severe skin complication and made chronic permanent radiation ulcers became a special part in outpatient department of plastic surgeon. No literatures discussed about the treatment details for this dilemma to our knowledge. Aim and Objectives: The study focus on the management for chronic permanent skin effects, which had no response to topical agent and treatment. Materials and Methods: This is a retrospective chart review series in a single institute. From August, 2012 to May, 2015, there were 11 patients received surgical intervention by plastic surgeon. Results: Eleven patients with diagnoses of chronic radiation ulcers were referred from cardiovascular specialists or dermatologist and all received surgical debridement. Through the experience of repetitive debridements and surgeries for the former four cases, we found that the adequate debridement area should include the whole radiation area peripherally and deep to muscle fascia vertically. During the course of treatment, case No. 4 suffered another cardiac episode and couldn't take further operation for wound resurfacing. Vacuum assisted wound closure (VAC) system was applied as an alternative therapy. Based on above finding, radical excision with immediate wound closure was performed on the following 7 patients, which revealed successful outcomes. One of them had an incidental contusion over the wound resulting in partial dehiscence and wound infection, and it recovered well after debridement and wound care. All these 11 patients completed whole course of 20 sessions hyperbaric oxygen therapy. Conclusion: The ultimate therapy of refractory chronic permanent radiation ulcer is surgical debridement. One stage procedure of radical excision with immediate wound closure is the best solution for this special group in releasing their suffering and anesthetic risk. (J Taiwan Soc of Plast Surg.

並列關鍵字

fluoroscopy-induced radiation ulcer ； percutaneous coronary intervention ； surgery