From the Department of Neurosurgery.
Department of Surgery, Division of Plastic, Maxillofacial, and Oral Surgery.
Plast Reconstr Surg. 2024 Jan 1;153(1):221-231. doi: 10.1097/PRS.0000000000010568. Epub 2023 Apr 20.
Patients with oncologic spine disease face a high systemic illness burden and often require surgical intervention to alleviate pain and maintain spine stability. Wound healing complications are the most common reason for reoperation in this population and are known to impact quality of life and initiation of adjuvant therapy. Prophylactic muscle flap (MF) closure is known to reduce wound healing complications in high-risk patients; however, the efficacy in oncologic spine patients is not well established.
A collaboration at our institution presented an opportunity to study the outcomes of prophylactic MF closure. The authors performed a retrospective cohort study of patients who underwent MF closure versus a cohort who underwent non-MF closure in the preceding time. Demographic and baseline health data were collected, as were postoperative wound complication data.
A total of 166 patients were enrolled, including 83 patients in the MF cohort and 83 control patients. Patients in the MF group were more likely to smoke ( P = 0.005) and had a higher incidence of prior spine irradiation ( P = 0.002). Postoperatively, five patients (6%) in the MF group developed wound complications, compared with 14 patients (17%) in the control group ( P = 0.028). The most common overall complication was wound dehiscence requiring conservative therapy, which occurred in six control patients (7%) and one MF patient (1%) ( P = 0.053).
Prophylactic MF closure during oncologic spine surgery significantly reduces the wound complication rate. Future studies should examine the precise patient population that stands to benefit most from this intervention.
CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, III.
患有肿瘤脊柱疾病的患者面临着较高的全身疾病负担，通常需要手术干预来缓解疼痛和维持脊柱稳定性。在该人群中，伤口愈合并发症是再次手术的最常见原因，并且已知会影响生活质量和辅助治疗的开始。预防性肌肉皮瓣 (MF) 闭合已知可减少高风险患者的伤口愈合并发症；然而，其在肿瘤脊柱患者中的疗效尚未得到很好的确立。
我们机构的合作提供了一个研究预防性 MF 闭合效果的机会。作者对接受 MF 闭合的患者队列和在之前时间接受非 MF 闭合的患者队列进行了回顾性队列研究。收集了人口统计学和基线健康数据，以及术后伤口并发症数据。
共纳入 166 名患者，其中 MF 组 83 例，对照组 83 例。MF 组患者更有可能吸烟（P = 0.005），且既往脊柱照射发生率更高（P = 0.002）。术后，MF 组有 5 名患者（6%）发生伤口并发症，而对照组有 14 名患者（17%）（P = 0.028）。最常见的总体并发症是需要保守治疗的伤口裂开，对照组有 6 名患者（7%）和 1 名 MF 患者（1%）发生（P = 0.053）。
肿瘤脊柱手术中预防性 MF 闭合可显著降低伤口并发症发生率。未来的研究应研究最受益于这种干预的特定患者人群。
临床问题/证据水平：治疗性，III 级。
