Nuclear crisis and plastic surgery.

Sir,

The problem of radiation exposure in nuclear crisis is an interesting topic. In the present day, the effect of Fukushima crisis on health is widely discussed, and the topic in plastic surgery should also be mentioned. There are few reports on this specific topic. Indeed, plastic surgery is useful in reconstruction of severely irradiated and burnt cases. Also, the problem of nuclide exposure results in genetic alteration and can lead to congenital anomalies in the second and subsequent generations.[1] Exposure to radiation of more than 10 cGy is known to induce genetic alteration, which can lead to congenital disorders such as cleft lip, cleft palate and hydronephrosis.[2] Plastic surgery plays an important role in the surgical correction of many conditions that have an increased frequency in post-nuclear crisis situation (such as hydronephrosis,[3] cleft lip[4] and cleft palate[4]). The increased incidence of skin cancer in post irradiated cases requires a special mention. Basal cell carcinoma is reported as an important cancer in exposed subjects and long-term follow-up for skin cancer development is recommended in populations in contaminated areas.[5] Plastic surgery also plays a role in the management of such cancers.

A major concern is of the outcome of plastic surgery in radiation exposed subjects. In the post-operative phase there are more frequent complications because of subnormal immunity.[3] However, based on the observation on radical plastic operation in the post-Chernobyl crisis situation, there is no relationship between outcome to radiation exposure level and severity of the disease.[3] Hence, in the present 2011 nuclear crisis, special care and close follow-up might be required in plastic surgery cases in contaminated areas. Finally, the new approach via using new mesenchymal stem cell application can be the new hope for improving the outcome of plastic surgery in these individuals.[6]