Moore J, Isler M, Barry J, Mottard S
Orthopedic Surgery Division, Maisonneuve-Rosemont Hospital, Montreal, Canada.
Orthopedic Surgery Division, Maisonneuve-Rosemont Hospital, Montreal, Canada.
Eur J Surg Oncol. 2014 Dec;40(12):1671-6. doi: 10.1016/j.ejso.2014.10.045. Epub 2014 Oct 18.
Wound-healing complications represent an important source of morbidity in patients treated surgically for soft tissue sarcomas (STS). The purpose of this study was to determine which factors are predictive of major wound complication rates following STS resection, including tumor site, size, grade, and depth, as well as radiotherapy and chemotherapy.
We reviewed 256 cases of STS treated surgically between 2000 and 2011. The primary outcome was occurrence of major wound complications post STS resection.
Major wound complications were more likely to occur post STS resection with larger tumor diameters (p = 0.001), high grade tumors (p = 0.04), location in the proximal lower extremity (p = 0.01), and use of preoperative radiotherapy (p = 0.01). Tumors located in the adductor compartment were at highest risk of complications. We did not demonstrate a significant difference in complications rates based on method of closure. Diabetes, smoking, obesity, tumor diameter, tumor location in the proximal lower extremity, and preoperative radiotherapy were independent predictors on multivariate analysis.
There are multiple predictors for major wound complications post STS resection. A more aggressive resection irradiated soft tissues, combined with primary reconstruction, should be considered in cases with multiple risk factors.
伤口愈合并发症是软组织肉瘤（STS）手术治疗患者发病的重要原因。本研究的目的是确定哪些因素可预测STS切除术后的主要伤口并发症发生率，包括肿瘤部位、大小、分级和深度，以及放疗和化疗。
我们回顾了2000年至2011年间接受手术治疗的256例STS病例。主要结局是STS切除术后发生主要伤口并发症。
STS切除术后，肿瘤直径较大（p = 0.001）、高级别肿瘤（p = 0.04）、位于下肢近端（p = 0.01）以及使用术前放疗（p = 0.01）的患者更易发生主要伤口并发症。位于内收肌间隙的肿瘤发生并发症的风险最高。我们未发现基于缝合方法的并发症发生率有显著差异。多因素分析显示，糖尿病、吸烟、肥胖、肿瘤直径、肿瘤位于下肢近端以及术前放疗是独立的预测因素。
STS切除术后主要伤口并发症有多种预测因素。对于存在多种危险因素的病例，应考虑采用更积极的切除受照射软组织并结合一期重建的方法。
