Experiences when irradiating grafts and flaps for skin cancer

"Resection of skin cancer with graft or flap repair may be referred for local postoperative radiotherapy (PORT) to ensure local control." PORT needs to be delivered in a certain time frame after surgery, but this may impact on graft and flap survival. The purpose of this article is to pass on some experience our multidisciplinary team has acquired in order to assist in the management of these cases. Specifically, pertinent issues in patient assessment (history and examination), indications for PORT, the differences between a graft and a flap, and technical considerations in the prescription of radiotherapy to these are covered, accompanied by illustrative cases with appropriate photographs and diagrams. The principal findings are that a conservative approach may need to be taken to ensure graft and flap survival, with PORT reserved for a role in salvage. Other interesting cases cover the lack of acute radiation side effects in flaps; the tendency of acute radiation skin toxicity to move with gravity, and transplanted skin may have a different radiation sensitivity to that of its new environment. We hope that this article will be of use for the multidisciplinary skin oncology team. Further research is needed to validate and confirm our findings.