Despite advance radiotherapy techniques, long-term complications of radiation injury are still commonly seen. Acute effects are largely time dependent and can be controlled by alteration of therapy schedule. Chronic effects are dose dependent, and are associated with increased fibrosis and decreased vascularity which can lead to tissue necrosis, infection, and ulceration. The damaging effects of radiation therapy may not be clinically apparent for months or even years after treatment is given. The most commonly accepted theory explaining the effects of radiation injury on tissue healing has focused on decreased vascularity and hypoxia in affected tissues. More recently, impaired leukocyte function has been implicated as an additional factor in the pathophysiology of radiation injury. Reconstructive surgical plans may require alteration when operating in a radiated field, especially in the head and neck. Radiation wounds are best treated by standard, accepted techniques of thorough debridement and coverage with well-vascularized tissue. Hyperbaric oxygen may have a role in the management of early radiation injury or in prophylaxis against postoperative wound complications.

Mathes, Alexander, , , , , , , (1996). Radiation injury. Surgical oncology clinics of North America, 1996 Oct;5(4):809-24. https://www.ncbi.nlm.nih.gov/pubmed/8899946