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Radiation-induced wounds are extremely difficult to treat. They may lead to severe infections and can even be life-threatening. Wound dressings, negative pressure wound treatment, hyperbaric oxygen therapy, and antibiotics are the main treatment modalities for radiation-induced wounds. Amniotic membrane is the innermost surface of the placenta. It has been shown that amniotic membrane induces re-epithelization, regulates angiogenesis, and decreases inflammation and fibrosis. Our proposed theory was that amniotic membrane can have a role in treating radiation-induced wounds by inducing epithelization and increasing wound tensile strength. Out of 24 rats, 3 groups were composed. In group A, 21 days after one session of radiotherapy, a 2-cm incision was made on the gluteal region then an amniotic membrane was placed under the skin flaps. In group B, 21 days after one session of radiotherapy, a 2-cm incision made on the gluteal region and wound is sutured back after 2 × 2 cm of area was undermined. In group C, no radiotherapy is given. We just made an incision and sutured it back again with the same size of area undermined. Three weeks after these surgeries, wound regions were excised en bloc and taken out for biomechanical and histopathological assessments. The end results in amniotic membrane group (group A) were statistically higher than those in the other groups in the terms of wound healing and biomechanical measurements. After biomechanical and histopathological evaluation, amniotic membrane, with its antimicrobial, anti-inflammatory, angiogenic, and epithelial-inductive effects, was found to be affective in post-radiation wound treatment. Due to the features of amniotic membrane mentioned above, it can be an option in treatment of patients which received neoadjuvant radiotherapy to prevent future wounds. It can also be used for the care and treatment of post-radiation wounds. Level of Evidence: Not ratable

Besides conventional flaps, intercostal artery perforator flaps have been reported to cover trunk defects. In this report the use of anterior intercostal artery perforator (AICAP) flap, lateral intercostal artery perforator (LICAP) flap and dorsal intercostal artery perforator (DICAP) flap for thoracic, abdominal, cervical, lumbar and sacral defects with larger dimensions and extended indications beyond the reported literature were reevaluated. Thirty-nine patients underwent surgery between August 2012 and August 2014. The age of the patients ranged between 16 and 79 with a mean of 49 years. The distribution of defects were as follows; 12 thoracic, 8 parascapular, 3 cervical, 8 abdominal, 4 sacral and 4 lumbar. AICAP, LICAP and DICAP flaps were used for reconstruction. Fifty-two ICAP flaps were performed on 39 patients. Flap dimensions ranged between 6 × 9 cm and 14 × 35 cm. Twenty-six patients had single flap coverage and 13 patients had double flap coverage. Forty-six flaps have been transferred as propeller flaps and 6 flaps have been transferred as perforator plus flap. Forty flaps (75%) went through transient venous congestion. In one DICAP flap, 30% of flap was lost. No infection, hematoma or seroma were observed in any patient. Follow-up period ranged between 3 and 32 months with a mean of 9 months. The ICAP flaps provide reliable and versatile options in reconstructive surgery and can be used for challenging defects in trunk.

Besides conventional flaps, intercostal artery perforator flaps have been reported to cover trunk defects. In this report the use of anterior intercostal artery perforator (AICAP) flap, lateral intercostal artery perforator (LICAP) flap and dorsal intercostal artery perforator (DICAP) flap for thoracic, abdominal, cervical, lumbar and sacral defects with larger dimensions and extended indications beyond the reported literature were reevaluated. Thirty-nine patients underwent surgery between August 2012 and August 2014. The age of the patients ranged between 16 and 79 with a mean of 49 years. The distribution of defects were as follows; 12 thoracic, 8 parascapular, 3 cervical, 8 abdominal, 4 sacral and 4 lumbar. AICAP, LICAP and DICAP flaps were used for reconstruction. Fifty-two ICAP flaps were performed on 39 patients. Flap dimensions ranged between 6 × 9 cm and 14 × 35 cm. Twenty-six patients had single flap coverage and 13 patients had double flap coverage. Forty-six flaps have been transferred as propeller flaps and 6 flaps have been transferred as perforator plus flap. Forty flaps (75%) went through transient venous congestion. In one DICAP flap, 30% of flap was lost. No infection, hematoma or seroma were observed in any patient. Follow-up period ranged between 3 and 32 months with a mean of 9 months. The ICAP flaps provide reliable and versatile options in reconstructive surgery and can be used for challenging defects in trunk.