Zolper Elizabeth G, Saleem Meher A, Kim Kevin G, Mishu Mark D, Sher Sarah R, Attinger Christopher E, Fan Kenneth L, Evans Karen K
Georgetown University School of Medicine, Washington, DC, USA.
Department of Plastic and Reconstructive Surgery, MedStar Georgetown University Hospital, Washington, DC, USA.
Arch Plast Surg. 2021 Nov;48(6):599-606. doi: 10.5999/aps.2020.02061. Epub 2021 Nov 15.
Postoperative dehiscence and surgical site infection after spinal surgery can carry serious morbidity. Multidisciplinary involvement of plastic surgery is essential to minimizing morbidity and achieving definitive closure. However, a standardized approach is lacking. The aim of this study was to identify effective reconstructive interventions for the basis of an evidence-based management protocol.
A retrospective review was performed at a single tertiary institution for 45 patients who required 53 reconstruction procedures with plastic surgery for wounds secondary to spinal surgery from 2010 to 2019. Statistical analysis was performed for demographics, comorbidities, and treatment methods. Primary outcomes were postoperative complications, including dehiscence, seroma, and infection. The secondary outcome was time to healing.
The overall complication rate was 32%, with dehiscence occurring in 17%, seroma in 15% and infection in 11% of cases. Median follow-up was 10 months (interquartile range, 4-23). Use of antibiotic beads did not affect rate of infection occurrence after wound closure (P=0.146). Use of incisional negative pressure wound therapy (iNPWT) was significant for reduced time to healing (P=0.001). Patients treated without iNPWT healed at median of 67.5 days while the patients who received iNPWT healed in 33 days. Demographics and comorbidities between these two groups were similar.
This data provides groundwork for an evidence-based approach to soft tissue reconstruction and management of dehiscence after spinal surgery. Timely involvement of plastic surgery in high-risk patients and utilization of evidence-based interventions such as iNPWT are essential for improving outcomes in this population.
脊柱手术后的伤口裂开和手术部位感染可能导致严重的发病情况。整形外科的多学科参与对于将发病率降至最低并实现最终闭合至关重要。然而，目前缺乏标准化的方法。本研究的目的是确定有效的重建干预措施，为基于证据的管理方案奠定基础。
在一家单一的三级医疗机构对2010年至2019年期间因脊柱手术后继发性伤口而需要进行53次整形外科重建手术的45例患者进行了回顾性研究。对人口统计学、合并症和治疗方法进行了统计分析。主要结局是术后并发症，包括伤口裂开、血清肿和感染。次要结局是愈合时间。
总体并发症发生率为32%，其中伤口裂开发生率为17%，血清肿发生率为15%，感染发生率为11%。中位随访时间为10个月（四分位间距，4 - 23）。使用抗生素珠对伤口闭合后的感染发生率没有影响（P = 0.146）。使用切口负压伤口治疗（iNPWT）对缩短愈合时间有显著意义（P = 0.001）。未接受iNPWT治疗的患者愈合中位时间为67.5天，而接受iNPWT治疗的患者在33天内愈合。这两组患者的人口统计学和合并症情况相似。
该数据为脊柱手术后软组织重建和伤口裂开管理的循证方法提供了基础。整形外科及时介入高危患者并采用如iNPWT等循证干预措施对于改善该人群的治疗效果至关重要。
