Fluoroscopy and embolisation are an essential part of managing spinal arteriovenous malformations. In many of these patients, open surgery carries significant risk and embolisation of the AVM is the treatment of choice. Although radiation skin injury is a recognised side effect of therapeutic radiation; it is an unacceptable iatrogenic injury in fluoroscopic procedures.
Skin injuries are dose related with prolonged or repetitive fluoroscopic exposure resulting in skin necrosis and a painful, non healing wound. It only takes one hour of fluoroscopic exposure with a dose exceeding 1Gy to lead to radiation injury (1). These wounds often present in a delayed fashion and are difficult to manage as they occur within a compromised, irradiated field which limits local surgical solutions. There are few published reports on their management, as fortunately, they are relatively rare.
Presented are five cases of iatrogenic radiation injury secondary to embolisation/angiography of spinal AVM that have been managed within the Hutt Valley DHB from 2015-2020. All patients sustained full thickness necrosis injuries to the back corresponding to the spinal level of radiation. The patient age range was 56-70yo with 3 males and 2 females. Patients had an average of 2.8 fluoroscopic procedures with an average cumulative time of 226min and an average total radiation exposure of 14.5Gy. The 5 cases were managed with a combination of grafting, local flap, fat grafting, dermal substitute, negative pressure dressings and expectant management. A literature search using MeSH terms “radiation”, “screening”, “angiography”, “skin injury” “fluoroscopy” and “radiation burns” was performed and provided limited guidance in the corrective surgical management of these injuries. We discuss the management of individual cases and present the latest literature.