After the diagnosis of radiation skin injury, the local injury wounds should be treated with pain relief, infection prevention, and wound healing promotion as the principles. The combination of systemic treatment and local treatment can improve the systemic condition, which is conducive to promoting the healing of local injury wounds; and the effect of local injury treatment directly affects the treatment of systemic radiation sickness.
1. Systemic treatment
Systemic treatment is mainly based on the severity of the disease, and comprehensive treatment measures are taken. For patients with radiation sickness or excessive exposure, corresponding measures should be taken according to the different stages of disease development. Mainly include strengthening nutrition and strengthening anti-infection measures, including cleaning the ward environment, rational application of effective antibiotics; paying attention to water, electrolyte and acid-base balance; using various proteolytic enzyme inhibitors, free radical scavengers and increasing immune function as appropriate drugs; if necessary, drugs to improve microcirculation can be used.
For the damage to the body (such as electrolyte imbalance, damage to liver and kidney functions, etc.) after the absorption of toxic substances caused by the exudation of body fluids and the decomposition of necrotic tissue caused by the reaction period of large-scale skin damage, timely treatment measures should be taken; chronic In cases of radiation injury, attention should be paid to improving nutritional status, correcting hypoalbuminemia, and improving body resistance.
2. Treatment of local wounds
Local treatment includes analgesia, wound dressing change, anti-infection and wound closure. When local swelling and pain continue to increase, glucocorticoids can be used to reduce local swelling and pain, and analgesics can be used rationally. Infusion of gamma globulin and mesenchymal stem cells (MSCs) can enhance immunity, promote the separation of necrotic tissue and the growth of granulation tissue.
3. Wound treatment of acute radiation skin injury
Depending on the extent of the injury and the development of the disease course, appropriate measures are taken:
①I, II degree radiation skin damage or III, IV degree radiation damage before the blisters appear on the skin, prevent the local skin from being mechanically stimulated, and avoid ultraviolet and far-infrared radiation. Local cold compresses, antipruritic and pain relievers can be used, and antihistamines or corticosteroids can be used if necessary.
②When blisters appear in grades III and IV radioactive skin damage, care should be taken to protect the blisters in the early stage to prevent the blisters from bursting. Antibacterial dressings were used to cover the wounds and pressure bandages were applied.
③ If the blisters rupture and ulcerate, anti-inflammatory ointment and various functional dressings can be used for anti-inflammatory, pain relief, moisturizing, etc., and the wound will be closed in time after entering the recovery period.
Clinical practice has proved that early wound closure is one of the main measures to relieve pain. Various biological dressings (allogeneic skin, xenograft, etc.) can temporarily cover the wound surface, which can play a good pain relief effect; if necessary, cover the wound surface with autologous skin transplantation. , the pain can be relieved. Negative pressure sealing drainage technology (NPWT), using NPWT dressing and biological semi-permeable membrane to isolate the wound from the external environment, thereby reducing the chance of contact with germs and the risk of infection. At the same time, continuous negative pressure is conducive to timely removal of wound exudate, improving blood circulation in the basal tissue of the wound, and facilitating the formation of new granulation tissue.
The wound surface of grade IV injury is difficult to heal, and the wound surface should be repaired by early excision and various tissue transplantation methods. Surgery can be performed after the peak of the reaction period (4-6 weeks); in the case of large-scale severe radiation-induced skin damage accompanied by systemic radiation sickness, the wound should be healed or mostly healed before the extreme stage of radiation sickness. Treatment creates favorable conditions.
Wound repair involves multidisciplinary technical issues such as plastic surgery, repair and reconstruction surgery, and microsurgery. Currently, tissue transplantation and repair is one of the important means of treating severe radiation-induced skin damage. Various vascularized skin flaps and musculocutaneous flaps have been widely used in the field of radiation injury, and have received good therapeutic effects, curing many large and deep severe radiation ulcers that were considered difficult to repair in the past.
4. Wound treatment of chronic radiation skin injury
For chronic radiation dermatitis, avoid stimulation by various physical and chemical factors, and apply topical antipruritic and emollient neutral oily creams and ointments, such as antipruritic cooling oil, egg yolk oil, etc. Medicated creams, ointments or herbal soaks to soften the stratum corneum.
For chronic radiation ulcers, dressing changes should be strengthened to control infection. Anti-inflammatory liquid dressings and external silver ion dressings can be used. For smaller and shallower ulcers, epidermal growth factor (EGF), fibroblast growth factor (FGF), Zn-containing cream and ointment can be used to promote wound healing after the infection is basically controlled; Unhealed ulcers should be surgically removed as soon as possible and repaired in time to prevent serious complications once the infection is basically controlled and the general condition allows.