Chapter 25: Wound management
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Post‐procedural considerations
Radiation damage continues and peak skin reaction can occur up to 14 days after radiation treatment. If skin breakdown occurs, the patient should be advised to return to the department for assessment and treatment. It may be necessary to refer the patient to the community nursing team, but ideally the radiotherapy department will monitor patients with severe skin reactions until they show clear signs of healing. Severe, RTOG grade 3, confluent moist desquamation can take several (6 + ) weeks to heal.
Long‐term considerations
Skin that has been exposed to high‐dose radiation may always show the effects of the treatment and will react differently to untreated skin. Any future skin breakdown may be very complex and wounds within the treated area will heal more slowly (Dormand et al. [32]). If the patient is given chemotherapy it may cause a flare of skin reaction in the area previously treated with radiotherapy (Ristic [117]). Irradiated skin may always remain darker than un‐irradiated skin. There can be microvascular damage in the form of telangiectasia which appears as a covering of broken capillaries below the skin. The skin and underlying soft tissue can become atrophic and fibrotic such that the patient feels tightness and a lack of flexibility in the previously irradiated area.
