Case study: the role of surgical debridement and dural patching in the prevention of a recurrent radiation-induced sacral ulcer.

The effects of radiation are not tissue selective. Changes are consistent with thermal injury, but evolve in a more insidious manner. Erythema, edema, itching, and osteonecrosis can occur. These changes, over the sacrum, can lead to a spinal cutaneous fistula with persistent cerebrospinal fluid (CSF) leak in association with ulceration. Soft tissue coverage alone appears to be inadequate treatment. Aggressive bony debridement with dural patching have prevented recurrence of the fistula in a recent case.