Introduction: The literature is devoid of articles discussing the effects of external beam radiation on previously skin grafted areas. Skin grafts are therefore not commonly utilized if postoperative radiotherapy is planned. However at our institution patients with skin grafts will still proceed onto radiotherapy if needed, usually with good success. The objective of this study was therefore, to evaluate the outcome of all split thickness skin grafts that had been postoperatively treated with external beam radiation therapy.

Methods: The charts of all reconstructions requiring skin grafts (with or without flap) that required post operative radiotherapy at a single cancer institution between Jan 2000- Jan 2002 were retrospectively reviewed. Variables evaluated included, the reconstructive needs, the size of the graft, length of hospital stay, interval between the skin graft and radiotherapy, total dose of radiotherapy, delays in treatment, wound complications in the radiated areas, and length of follow up.

Results: There were 13 patients (9 males, 4 females) who matched the criteria for this study. The mean age was 62.9 years (range 34-77 years). The mean follow-up for these patients was 16.8 months (2-24 months). The pathologic diagnoses included; sarcoma (9), squamous cell carcinoma (3), melanoma (1) and basal cell carcinoma (1). The mean skin graft area was 146 sq cm (range 24-420sq cm). All grafts were placed on healthy vascular tissue beds of which 10 grafts (77%) were used to cover muscle flaps (8 local muscle flaps, 2 free muscle flaps). Mean time to initial radiotherapy after the split thickness graft was 7.5 weeks (range 6-12 weeks).There was no delay or interruption in treatment due to wound healing problems. The mean dose of radiotherapy was 5800cGy (range2400-6600). There were only 2 cases of partial skin graft loss (<20%) post radiation that healed with conservative treatment. Conclusions: Split thickness skin grafts can tolerate postoperative radiotherapy without significant complications. External beam radiation can be safely initiated as early as 6 weeks after the operation. If postoperative radiotherapy is required, split thickness grafts should ideally be placed on well vascularized muscle beds. In cases where minor skin graft loss occurs secondary to the radiation treatment or other factors, these areas usually respond to conservative treatment without the need for revisional surgery.