复杂的头皮肿瘤切除与重建：发病率和死亡率的预测因素

Complex oncologic resection and reconstruction of the scalp: Predictors of morbidity and mortality.

作者信息

Tecce Michael G, Othman Sammy, Mauch Jaclyn T, Nathan Shelby, Tilahun Estifanos, Broach Robyn B, Azoury Saïd C, Kovach Stephen J

机构信息

Division of Plastic Surgery, Department of Surgery, University of Pennsylvania, Philadelphia, PA, USA.

出版信息

Arch Craniofac Surg. 2020 Aug;21(4):229-236. doi: 10.7181/acfs.2020.00206. Epub 2020 Aug 20.

DOI:10.7181/acfs.2020.00206

PMID:32867412

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC7463124/

Abstract

BACKGROUND

Oncologic resection of the scalp confers several obstacles to the reconstructive surgeon dependent upon patient-specific and wound-specific factors. We aim to describe our experiences with various reconstructive methods, and delineate risk factors for coverage failure and complications in the setting of scalp reconstruction.

METHODS

A retrospective chart review was conducted, examining patients who underwent resection of fungating scalp tumors with subsequent soft-tissue reconstruction from 2003 to 2019. Patient demographics, wound and oncologic characteristics, treatment modalities, and outcomes were recorded and analyzed.

RESULTS

A total of 189 patients were appropriate for inclusion, undergoing a range of reconstructive methods from skin grafting to free flaps. Thirty-three patients (17.5%) underwent preoperative radiation. In all, 48 patients (25.4%) suffered wound site complications, 25 (13.2%) underwent reoperation, and 47 (24.9%) suffered from mortality. Preoperative radiation therapy was an independent risk factor for wound complications (odds ratio [OR], 2.85; 95% confidence interval [CI], 1.1-7.3; p = 0.028) and reoperations (OR, 4.45; 95% CI, 1.5-13.2; p = 0.007). Similarly, the presence of an underlying titanium mesh was an independent predictor of wound complications (OR, 2.49; 95% CI, 1.1-5.6; p= 0.029) and reoperations (OR, 3.40; 95% CI, 1.2-9.7; p= 0.020). Both immunosuppressed status (OR, 2.88; 95% CI, 1.2-7.1; p= 0.021) and preoperative radiation therapy (OR, 3.34; 95% CI, 1.2-9.7; p= 0.022) were risk factors for mortality.

CONCLUSION

Both preoperative radiation and the presence of underlying titanium mesh are independent risk factors for wound site complications and increased reoperation rates following oncologic resection and reconstruction of the scalp. Additionally, preoperative radiation, along with an immunosuppressed state, may predict patient mortality following scalp resection and reconstruction.

摘要

背景

头皮肿瘤切除手术给重建外科医生带来了诸多障碍，这些障碍取决于患者个体因素和伤口因素。我们旨在描述我们采用各种重建方法的经验，并阐明头皮重建中覆盖失败和并发症的危险因素。

方法

进行了一项回顾性病历审查，研究对象为2003年至2019年间接受头皮真菌性肿瘤切除并随后进行软组织重建的患者。记录并分析患者的人口统计学资料、伤口和肿瘤特征、治疗方式及结果。

结果

共有189例患者符合纳入标准，接受了从植皮到游离皮瓣等一系列重建方法。33例患者（17.5%）接受了术前放疗。总共有48例患者（25.4%）出现伤口部位并发症，25例（13.2%）接受了再次手术，47例（24.9%）死亡。术前放疗是伤口并发症（比值比[OR]，2.85；95%置信区间[CI]，1.1 - 7.3；p = 0.028）和再次手术（OR，4.45；95% CI，1.5 - 13.2；p = 0.007）的独立危险因素。同样，存在潜在钛网是伤口并发症（OR，2.49；95% CI，1.1 - 5.6；p = 0.029）和再次手术（OR，3.40；95% CI，1.2 - 9.7；p = 0.020）的独立预测因素。免疫抑制状态（OR，2.88；95% CI，1.2 - 7.1；p = 0.021）和术前放疗（OR，3.34；95% CI，1.2 - 9.7；p = 0.022）均为死亡的危险因素。