Althumairi Azah A, Canner Joseph K, Gearhart Susan L, Safar Bashar, Sacks Justin, Efron Jonathan E
Department of Surgery, Johns Hopkins University School of Medicine, 600 N. Wolfe Street, Baltimore, MD, 21287, USA.
Center for Surgical Trials and Outcomes Research, Johns Hopkins University School of Medicine, Baltimore, MD, USA.
World J Surg. 2016 Jul;40(7):1755-62. doi: 10.1007/s00268-016-3450-0.
Perineal wound following abdominoperineal resection (APR) is associated with high complication rate and delayed healing. We aim to evaluate the risk factors for delayed wound healing and wound complications following APR.
A retrospective review of patients who underwent APR was performed. Non-delayed wound healing occurred within 6 weeks. Major complications included infection, necrosis, and dehiscence that required surgical interventions. Minor complications included drainage and superficial dehiscence that were treated conservatively. Patients were compared for type of wound closure (primary vs. flap reconstruction). Effect of patients' demographic and clinical variables on time to healing, and on major and minor wound complications was examined.
215 patients were identified, of which 175 (81 %) had primary closure and 40 (19 %) had flap reconstruction. Overall, major wound complications occurred in 14 (7 %) of patients and minor wound complications occurred in 48 (22 %). Mean time to wound healing was 6.3 weeks in the primary closure group and 9.3 weeks in the flap reconstruction group (p = 0.02). Delayed wound healing occurred in 44 (25 %) of the primary closure group and in 25 (62 %) of the flap reconstruction group (p < 0.001). Delayed wound healing was associated with smoking (p = 0.005), hypoalbuminemia (p = 0.05), neoadjuvant chemotherapy (p = 0.02), and flap reconstruction (p = 0.03). Hypoalbuminemia was associated with major wound complications (p = 0.002), while neoadjuvant chemotherapy was associated with minor wound complications (p = 0.01).
Wound complications and delayed healing are related to patients' nutritional status, smoking, and neoadjuvant chemotherapy. Patients with these risk factors are at risk of delayed wound healing even if they underwent flap reconstruction.
腹会阴联合切除术（APR）后的会阴伤口并发症发生率高且愈合延迟。我们旨在评估APR后伤口愈合延迟及伤口并发症的危险因素。
对接受APR的患者进行回顾性研究。伤口未延迟愈合是指在6周内愈合。主要并发症包括感染、坏死和裂开，需要手术干预。次要并发症包括引流和浅表裂开，采用保守治疗。比较患者的伤口闭合类型（一期缝合与皮瓣重建）。研究患者的人口统计学和临床变量对愈合时间以及主要和次要伤口并发症的影响。
共纳入215例患者，其中175例（81%）采用一期缝合，40例（19%）采用皮瓣重建。总体而言，14例（7%）患者发生主要伤口并发症，48例（22%）患者发生次要伤口并发症。一期缝合组伤口愈合的平均时间为6.3周，皮瓣重建组为9.3周（p = 0.02）。一期缝合组44例（25%）出现伤口愈合延迟，皮瓣重建组25例（62%）出现伤口愈合延迟（p < 0.
