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.
KEY WORDS
Non-healing ulcer - radioisotope burns - reconstructive surgery - unstable scar
