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Ajai Jain (43) and Deepak Jain (33), owners of scrap material shops in Mayapuri, West Delhi, were accidentally exposed to Cobalt-60, leading to "non-healing ulcers".
Ajai had ulcers on the hip and thigh. The source was a a tiny "pin" of the radioactive material that he had kept unknowingly in his wallet for 20 days. Deepak who was exposed to radiation from the scrap that he had brought, sustained burns which left an ulcer on his upper arm. The decay of Cobalt-60 results in gamma radiation, which is known to have high penetrative effects in the tissues.
Dr S S Gambhir, consultant plastic surgeon at Sir Ganga Ram Hospital, where plastic and reconstructive surgery of the two patients was done after initial treatment at the Army (Research and Referral) Hospital, said, "In India, there is hardly any experience of accidental radiation exposure injuries. We do have some experience of treating ulcers in patients who undergo radiotherapy for cancer, but it is localised radiation, in a predetermined, monitored quantity."
But in accidental exposure, the quantum of radiation exposure cannot be predicted and can affect any part of the body. The effects can spread with time, Dr Gambhir said.
In Ajai's case, the ulcers were only in the anterior part of his body, but after nearly a year, "patches" started appearing on the front of his thigh as well.
Doctors had to surgically clean the wounds — a procedure known as debridement — and then take skin grafts. Flaps were surgically removed from other parts of the body and attached over the open wounds in lengthy procedures that involved at least 10 to 11 surgeries over a year.
"There is damage at a cellular-level in radiation burns, so we needed to debride it and then cover the open wounds with vascularised tissues — those that carry their own blood supply," Dr Gambhir said.
Wounds from radiation exposure, doctors said, present a tough challenge because of the need to provide viable vascularised tissue covers surgically. Ajai and Deepak said their ulcers kept increasing.
"It took me some time to walk properly because they had to graft skin from my leg and abdomen on my wounds. Before this, I visited so many hospitals in Delhi and even contacted experts in Mumbai. Everyone said they had no experience to surgically treat open radiation wounds," Ajai said.
Both patients were admitted in private hospitals before they were referred to Army Hospital.