BACKGROUND: Radiation-induced fibrosis (RIF) is one of the severe long-term side 
effects of radiation therapy (RT) with a crucial impact on the development of 
postoperative wound healing disorders (WHD). The grades of fibrosis vary between 
mild to severe depending on individual radiosensitivity. In this study, we have 
investigated the molecular pathways that influence RIF and have correlated data 
from immunohistochemistry (IHC) for von -Willebrand Factor (vWF) and from 
Real-Time Polymerase Chain Reaction (RT-PCR) concerning markers such as 
Transforming Growth Factor (TGF)-β 1, and vWF, with clinical data concerning the 
occurrence of WHD during follow-up.
METHODS: Expression profiles of the genes encoding TGF-β 1, vWF, and 
α-procollagen (PC) were analyzed, by RT-PCR, in specimens from patients with 
(n = 20; 25.6 %) and without (n = 58; 74.4 %) a history of previous RT to the 
head and neck. Moreover, IHC against vWF was performed. Clinical data on the 
occurrence of cervical WHDs were analyzed and correlated.
RESULTS: A statistically significant increase in the expression profiles of α-PC 
and TGF-β 1 was observed in previously irradiated skin samples (occurrence of RT 
>91 days preoperatively). vWF showed a statistically significant increase in 
non-irradiated tissue. Moreover, analysis of expression profiles in patients 
with and without WHDs during follow-up was performed. IHC showed a reduced 
amount of vessels and structural changes in epidermal tissue post-RT.
CONCLUSIONS: The expression of markers of fibrosis and angiogenesis was analyzed 
in order to gain insight into molecular pathways that account for structural 
changes in irradiated skin and that eventually lead to WHDs. The results are 
congruent with reports from the literature and are a possible starting point for 
further research, as anti-TGF-β 1 treatment, for example, could represent new 
therapeutic opportunities in the management of previously irradiated patients.