Devulapalli Chris, Broyles Justin M, Bello Ricardo, Elgendy Tarek, Yalanis Georgia, Redett Richard, Rosson Gedge D, Sacks Justin M
Baltimore, Md.
From the Department of Plastic and Reconstructive Surgery, The Johns Hopkins Hospital.
Plast Reconstr Surg. 2017 Oct;140(4):806-814. doi: 10.1097/PRS.0000000000003679.
Spinal resections can lead to defects requiring soft-tissue reconstruction. The purpose of this study was to review the authors' institutional experience with reconstruction of spinal defects and identify risk factors predictive of wound complications, focusing on timing of reconstruction with ablative surgery.
The authors retrospectively reviewed patients who underwent spinal resection and required soft-tissue reconstruction from 2002 to 2014. Logistic regression was performed to identify risk factors for complications.
Of 289 reconstructions performed in 259 patients, 64 cases (22.1 percent) had major wound complications requiring reoperation. Lumbosacral defects were the most common location (43.6 percent) and paraspinous muscle flaps were the preferred reconstructive method used for all defect regions. A total of 224 reconstructions (77.5 percent) were performed immediately at the time of spinal surgery, and 65 (22.5 percent) were performed in delayed fashion as a result of wound complications from previous spinal surgery. Patients undergoing immediate reconstruction had significantly lower rates of instrumentation removal (0.9 percent versus 4.6 percent; p = 0.043), unplanned reoperations (0.5 versus 1.3; p < 0.001), and mortality (0.9 percent versus 9.2 percent; p < 0.001) compared with those undergoing delayed reconstruction. On logistic regression analysis, presence of instrumentation (OR, 3.2; p = 0.012), requirement for a free flap (OR, 9.0; p = 0.016), and spinal cord exposure (OR, 2.6; p = 0.036) were associated with increased odds of a major wound complication.
Spinal resections carry significant surgical-site morbidity, and selection of high-risk patients for immediate reconstruction with locoregional muscle flaps may be beneficial for improving wound-related outcomes.
CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, III.
脊柱切除术可导致需要软组织重建的缺损。本研究的目的是回顾作者所在机构脊柱缺损重建的经验，并确定预测伤口并发症的危险因素，重点关注与切除手术相关的重建时机。
作者回顾性分析了2002年至2014年期间接受脊柱切除术并需要软组织重建的患者。采用逻辑回归分析确定并发症的危险因素。
259例患者共进行了289次重建手术，其中64例（22.1%）发生了需要再次手术的严重伤口并发症。腰骶部缺损是最常见的部位（43.6%），椎旁肌瓣是所有缺损区域首选的重建方法。总共224次重建手术（77.5%）在脊柱手术时立即进行，65次（22.5%）因先前脊柱手术的伤口并发症而延迟进行。与延迟重建的患者相比，立即重建的患者器械取出率（0.9%对4.6%；p = 0.043）、计划外再次手术率（0.5对1.3；p < 0.001）和死亡率（0.9%对9.2%；p < 0.001）显著更低。逻辑回归分析显示，使用内固定器械（比值比[OR]，3.2；p = 0.012）、需要游离皮瓣（OR，9.0；p = 0.016）和脊髓暴露（OR，2.6；p = 0.036）与严重伤口并发症的发生几率增加相关。
脊柱切除术具有显著的手术部位发病率，选择高危患者立即采用局部肌瓣进行重建可能有利于改善与伤口相关的结局。
临床问题/证据级别：治疗性研究，III级。
