Kennedy Sean, Mayo Zachary, Gao Yubo, Miller Benjamin J
The Musculoskeletal Oncology Research Initiative (
Iowa Orthop J. 2018;38:131-136.
Non-oncologic wound complications are common following resection of soft tissue sarcomas and factors predisposing to the development of complications have been extensively studied. To our knowledge, the methods and results of surgical treatment of these complications have not been reported. The purposes of this study were to 1) identify time to recognition, treatment employed, and eventual outcome of complications 2) investigate risk factors that may predispose patients to failure in management of complications following resection of soft tissue sarcomas.
This was a multi-institutional, retrospective case series of patients treated with a primary closure of a limb sparing resection of a soft tissue sarcoma of the pelvis or extremity who developed a non-oncologic wound complication requiring operative intervention. The primary outcomes were a healed wound at the end of treatment and the total number of procedures required to address the complication.
There were 61 patients from 11 institutions included in the analysis. The median time from surgery to the initial recognition of a complication was 22 days (range 0-173 days), with 51 patients (84%) presenting in the first six weeks postoperatively. The definitive procedures included primary closure (44), healing by secondary intention (9), muscle flap (6), and skin graft (2). No patient was treated with an amputation. Six patients (10%) had a wound requiring continued dressing changes. 12 patients (20%) required at least one (range 1-4) additional unplanned procedure. In a bivariate analysis, we found patients with an infection were at increased risk of requiring multiple unplanned procedures (p=0.024).
Limb sparing resection of a soft tissue sarcoma is known to be at high risk of postoperative wound complications. We found that complications uncommonly present greater than six weeks after initial treatment and surgical management predictably results in retention of the affected limb and a healed wound in those requiring operative treatment..
非肿瘤性伤口并发症在软组织肉瘤切除术后很常见，且对导致并发症发生的因素已进行了广泛研究。据我们所知，这些并发症的外科治疗方法和结果尚未见报道。本研究的目的是：1）确定并发症的识别时间、所采用的治疗方法及最终结局；2）调查可能使患者在软组织肉瘤切除术后并发症处理中失败的危险因素。
这是一项多机构的回顾性病例系列研究，研究对象为接受骨盆或四肢软组织肉瘤保肢切除一期缝合治疗后出现需要手术干预的非肿瘤性伤口并发症的患者。主要结局为治疗结束时伤口愈合以及处理并发症所需的手术总数。
分析纳入了来自11个机构的61例患者。从手术到首次识别并发症的中位时间为22天（范围0 - 173天），51例患者（84%）在术后六周内出现并发症。确定性手术包括一期缝合（44例）、二期愈合（9例）、肌皮瓣（6例）和植皮（2例）。无患者接受截肢治疗。6例患者（10%）伤口需要持续换药。12例患者（20%）需要至少一次（范围1 - 4次）额外的非计划手术。在双变量分析中，我们发现感染患者需要进行多次非计划手术的风险增加（p = 0.024）。
已知软组织肉瘤保肢切除术后伤口并发症风险高。我们发现，并发症很少在初始治疗后六周以上出现，且手术治疗可预期地使患肢得以保留，伤口在需要手术治疗的患者中实现愈合。
