title: Persistent cutaneous ulcers after Yttrium-90 synovectomy, an unusual complication: two case reports and a review of the literature.
abstract: Development of persistent deep cutaneous ulceration is a rare and serious complication of radiosynovectomy, an extended procedure used in the treatment of chronic synovitis. Cutaneous radiation necrosis is a rare complication of synovectomy, probably as a result of radiocolloid para-articular injection. This rare phenomenon should be suspected when an ulcer adjacent to an articulation appears several days or even months after a radiation synovectomy. It can turn into a challenging diagnosis for rheumatologists, orthopaedists and dermatologists, especially in those cases with a late development of the skin lesions. Recognition of this potential side effect is important in order to establish a proper therapeutic strategy and avoid unnecessary treatments. Surgical excision appears to be the treatment of choice. We report two patients with knee osteoarthritis treated with intra-articular injection of Yttrium-90 who developed persistent cutaneous ulcers secondary to radiation necrosis.
authors.affiliation: Department of Dermatology, Hospital del Mar, Barcelona, Spain.
authors.forename: Lidia
authors.initials: L
authors.lastname: García-Colmenero
authors.affiliation: Department of Dermatology, Hospital del Mar, Barcelona, Spain.
authors.forename: Gemma
authors.initials: G
authors.lastname: Martin-Ezquerra
authors.affiliation: Department of Rheumatology, Hospital del Mar, Barcelona, Spain.
authors.forename: Jordi
authors.initials: J
authors.lastname: Monfort
authors.affiliation: Department of Dermatology, Hospital del Mar, Barcelona, Spain.
authors.forename: Ramon M
authors.initials: RM
authors.lastname: Pujol
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010003:Osteoarthritis / Q000532:radiotherapy*; D011878:Radiotherapy / Q000009:adverse effects*; D012883:Skin Ulcer / Q000150:complications / Q000209:etiology / Q000601:surgery*; D000074402:Synovectomy / Q000009:adverse effects*; D013585:Synovitis / Q000188:drug therapy* / Q000601:surgery; D016896:Treatment Outcome; D015021:Yttrium Radioisotopes / Q000009:adverse effects* / Q000627:therapeutic use*
chemical_list: D015021:Yttrium Radioisotopes; C000615496:Yttrium-90
keywords: Knee osteoarthritis; Rheumatoid arthritis; Synovitis; Treatment