Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, MD 21287, USA.
Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, MD 21287, USA; Department of Neurosurgery, Mayo Clinic, Rochester, MN 55905, USA.
Clin Neurol Neurosurg. 2021 Aug;207:106800. doi: 10.1016/j.clineuro.2021.106800. Epub 2021 Jul 9.
Surgical site infection and dehiscence are devastating complications of surgery for spinal metastases. Wound closure involving plastic surgeons has been proposed as a strategy to lower post-operative complications. Here we investigated whether plastic surgery closure is associated with lower rates of wound complications, wound infection, and wound reoperation compared to simple closure by spine surgeons.
Patients surgically treated for metastatic tumors at a single comprehensive cancer center between April 2013-2020 were retrospectively identified. Primary pathology, demographic information, clinical characteristics, pre-operative laboratory values, tumor location, operative characteristics, and post-operative outcomes were collected. Univariable analyses used student t-tests for continuous variables and χ tests for categorical variables. Multivariable regressions were performed to control for confounders.
We included 317 patients, of which 56 underwent closure by plastic surgeons and 291 by neurosurgeons. Patients in the plastic surgery cohort were more likely to have received prior radiation to the surgical site, more often on long-term corticosteroid therapy, and more likely to have sacrococcygeal tumors. Operations involving plastic surgeons were more likely to be revision surgeries, corpectomies, and to involve a staged approach. Additionally, patients in the plastic surgery cohort had longer incision lengths, longer surgeries, greater intraoperative blood loss (IOBL), were more likely to receive transfusions, and had longer hospitalizations. Local paraspinous advancement flaps were the most common complex wound closure technique. Plastic surgery closure was not significantly associated with a difference in rates of post-operative wound complications, wound infection, or wound-related reoperations compared to simple wound closure.
We identified that patients undergoing plastic surgery wound closure had worse baseline risk, longer surgeries, greater IOBL, and longer hospitalizations compared to patients receiving simple closure. Despite their increased risk, complex wound closure did not significantly alter the rates of post-operative wound complications, wound infection, or wound-related reoperations. Consideration may be given to plastic surgery closure in patients at high risk of wound complications or with extensive wound defects.
脊柱转移瘤术后手术部位感染和裂开是灾难性的并发症。涉及整形外科医生的伤口闭合已被提出作为降低术后并发症的策略。在这里，我们研究了与脊柱外科医生的简单闭合相比，整形外科医生的闭合是否与较低的伤口并发症、伤口感染和伤口再次手术率相关。
回顾性分析了 2013 年 4 月至 2020 年期间在一家综合性癌症中心接受转移性肿瘤手术治疗的患者。收集了主要病理、人口统计学信息、临床特征、术前实验室值、肿瘤位置、手术特征和术后结果。连续变量采用学生 t 检验，分类变量采用卡方检验。采用多元回归来控制混杂因素。
我们纳入了 317 名患者，其中 56 名患者由整形外科医生进行了闭合，291 名患者由神经外科医生进行了闭合。整形外科组的患者更有可能接受过手术部位的放射治疗，更常接受长期皮质类固醇治疗，更有可能患有尾骨肿瘤。涉及整形外科医生的手术更可能是翻修手术、椎体切除术，并涉及分期方法。此外，整形外科组的患者切口长度更长，手术时间更长，术中失血量（IOBL）更大，更有可能需要输血，住院时间更长。局部脊柱旁推进皮瓣是最常见的复杂伤口闭合技术。与简单伤口闭合相比，整形外科闭合与术后伤口并发症、伤口感染或与伤口相关的再次手术的发生率无显著差异。
我们发现，与接受简单闭合的患者相比，接受整形外科伤口闭合的患者基线风险更高，手术时间更长，术中失血量（IOBL）更大，住院时间更长。尽管风险增加，但复杂的伤口闭合并没有显著改变术后伤口并发症、伤口感染或与伤口相关的再次手术的发生率。对于伤口并发症风险较高或伤口缺陷广泛的患者，可以考虑进行整形外科闭合。
