How do you manage an open wound that is not healing after radiation treatment for an ulcerated SCC of the scalp?

There always has to be high suspicion for persistent disease, so consider a punch biopsy. Sometimes repeat biopsies are needed to confirm recurrence. Sometimes localized surgery without general anesthesia can be performed to freshen the wound and promote graft placement. Tertiary centers may have expertise to provide anesthesia for soft tissue flap repair. Wound care specialists can assist with best practices regarding promoting slow healing. Vitamin E 400 units BID and pentoxyphylline 400mg TID has been tried to help promote healing in the setting of osteoradionecrosis. Optimzing diabetic and cardiovascular management may be helpful. Hyperbaric oxygen treatments can also be tried. I have several patients with small areas of exposed bone th...