Management of radionecrosis of the vulva and distal vagina
Article Abstract:
Radiation therapy for cancer may be complicated by the delayed development of radiation-induced tissue injury. The frequency and degree of injury depends upon the dose of radiation. Radiation injuries are characterized by progressive fibrosis (the formation of fiber-like tissue) and loss of blood supply to the affected area. These conditions lead to necrosis, or tissue death. The skin is the most common site of radionecrosis, or radiation injury. Skin in the vulvar region (the female, external genital area) is more sensitive to radiation damage than other skin areas because it tends to be moist, uneven, abrasive, and rich in blood vessels. However, radiation injuries of the vulvar skin are rare, because cancers in this region are usually treated surgically. These radiation injuries are associated with pain and foul odor, and can be treated with pain-relieving drugs, antibiotics, removal of dead tissue, and intensive local care. Studies show that intensive conservative therapy is ineffective in treating this problem. The management of radionecrosis of the vulva and distal (outer) vagina in 12 patients is described. Radiation was used to treat vulvar cancer in seven patients, distal vaginal cancer in three patients, and recurrent cancer of the endometrium (the inner lining of the uterus) in two patients. Radionecrosis did not resolve spontaneously in any patient, and the average duration before surgical treatment was 8.5 months. The radiation injuries were managed by local therapy, extensive surgical removal of the affected area, or exenteration (surgical removal of viscera, or abdominal organs). The surgical wounds were closed off in three patients, and covered with extra skin from the local areas or skin and muscle tissue in seven patients. Radionecrotic ulcers persist in the two patients treated with local care and one patient with a closed surgical wound. One patient died after failure of repeated treatments, and the remaining patients healed. These findings suggest that radionecrosis of the vulva and/or distal vagina should be treated by surgical methods. (Consumer Summary produced by Reliance Medical Information, Inc.)
Publication Name: American Journal of Obstetrics and Gynecology
Subject: Health
ISSN: 0002-9378
Year: 1991
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The effects of cold therapy on postoperative pain in gynecologic patients: a prospective, randomized study
Article Abstract:
Cold therapy may not be an effective method for pain relief in women who have undergone an exploratory laparotomy. Cold therapy involves the application of a cold substance to a wound or injury to reduce pain. Among 27 women who received self-administered intravenous morphine after undergoing an exploratory laparotomy, 13 were given a cold pack and 12 were not given a cold pack. The women using a cold pack used significantly more intravenous morphine the day after surgery than the women not using a cold pack. The average amount of intravenous morphine used on the second day after surgery was similar among women in both groups. The cold pack is bulky and cumbersome to use and restricts movement. Ice packs or cold baths can reduce the amount of pain experienced by patients who have undergone other types of surgery.
Publication Name: American Journal of Obstetrics and Gynecology
Subject: Health
ISSN: 0002-9378
Year: 1993
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