Testimonial: How to manage a chronic wound of the face that occurred on an old radiation-induced skin sequelae… and the contribution of conservative solutions!

In 1967, when I was a teenager (15 years old), I was treated for embryonal sarcoma of the face (back of the left cheek) with limited facial surgery, followed by intensive chemotherapy and then brachytherapy. The latter consisted of the insertion of a source of iridium (local radioactive material) in plastic sheaths which passed through my cheek for 8 days, and which caused an immediate burn of the tissues of this area with significant suppuration which interfered with my diet, but also the formation of external thick crusts on the skin. The effects of this burn gradually disappeared with local care, but longer-term effects began to appear despite the satisfaction of the healing obtained!

These progressive side effects were aesthetic in nature, with the appearance of mottling on an increasingly hard and fragile skin and a progressive deformation of the jaw bone below, the growth of which does not was not completed. The effects were also functional, with the appearance of thick flanges stretched inside the cheek hindering the opening of the mouth (and pulling the lip to the side), while the muscles of the cheek melted, transforming gradually into a sort of limp drumhead that prevented me from opening my mouth and practicing perfect dental hygiene.

Thus dental care was made difficult, with a deterioration of the gums in a few years, becoming worrying when the bone was exposed and my teeth started to move. The state of my cheek was not too good either, because in addition to the “smile” modified for several years, I presented an inflammation of the skin followed by a fistulization (communication between the outside and the inside of the cheek through a hole) which was cured at the time by simple successive antibiotic treatments, but which did not bode well.

In 2013, then aged 61 (and 46 years after this radiotherapy), during a conference on the long-term effects of cancer treatments, I met the treasurer of the Association des Aguerris (association dedicated to follow-up of childhood cancers), patient himself carrying sequelae related to childhood radiotherapy. He pointed me to the work of Dr. Delanian who was following him on this subject.

During the consultation, Dr. Delanian was offered a PENTOCLO antifibrosis treatment, which I followed from 2013 to 2017, and which had a spectacular effect on my health: in 3 years, the bone of my upper jaw (maxilla) has become denser, the condition of my gums has improved with less mobile teeth, and the flanges inside my cheek have disappeared.

It was time, because just before this PENTOCLO treatment, I had to pull out two teeth that were moving at the IGR. These dental extractions were completed by mucosal flap cover surgery to prevent oral sinus communication, a potential source of serious infectious complications.

Finally at the beginning of 2020, during a routine examination, my city dermatologist noticed a skin lesion evoking radiation-induced basal cell carcinoma on my left cheek, and asked for a biopsy to find out for sure. Fortunately, this cheek biopsy turned out to be negative (no cancer), but caused a wound with delayed healing on my cheek (fistula that no longer closed).

Professor DELANIAN then consulted on this subject, put me back on PENTOCLO treatment to activate healing. After about a year, after an already clear improvement, she recommended that I complete this result with lipofilling because, even if I had healed, the tissue deficit was very significant. Lipofilling (injection of fat taken from the skin of the belly, therefore of fresh non-irradiated cells, then after centrifugation, reinjected where necessary) was carried out by a maxillofacial surgeon from the IGR in January 2021 A little over a month later, the result was almost perfect. A second injection of lipofilling should consolidate the first because the cells injected after the first injection often blend into the tissues that still lack thickness. The fistulized wound is now completely closed, my cheek seems to have regained a much better local state and I am very satisfied.

Bernard C.