Amendola Francesco, Ghiringhelli Gaia, Mela Alessandro, Miranda Sergio, Dolfato Elisa, Bulgarelli Eleonora, Diomedi Michele, Bonomi Stefano, Vaienti Luca, Luzzati Alessandro
From the Ospedale Galeazzi, Sant'Ambrogio, Milan, Italy.
Plast Reconstr Surg Glob Open. 2023 Sep 8;11(9):e5242. doi: 10.1097/GOX.0000000000005242. eCollection 2023 Sep.
Adjuvant radiation therapy following vertebrectomy is a major risk factor for local wound complications such as dehiscence, infection, and skin necrosis. In selected cases, well-vascularized coverage and modification of tension forces on the wound might reduce the risk of postoperative complications and reoperations. We aimed to demonstrate a reduction in general and specific complications in patients undergoing vertebral resection and flap coverage compared with vertebral resection alone.
We retrospectively analyzed and collected data from patients diagnosed with a tumor involving the spine and requiring a total or partial posterior vertebrectomy between January 2012 and October 2022, referred to a single tertiary-level orthopedic and trauma center. We included only patients in whom primary closure of the wound was possible but judged to be under excessive tension.
A total of 145 patients underwent partial or total vertebrectomy for oncological reasons at our tertiary-level trauma hospital. Among these, 73 patients were eventually included according to the inclusion and exclusion criteria: 53 in the orthopedic group and 20 in the orthoplastic group. Considering only patients undergoing radiation therapy, the orthoplastic group showed significantly lower rates of overall complications (33% versus 69%) than the orthopedic group.
Primary flap coverage, especially in patients receiving RT, reduces the risk of postoperative complications and avoids a second reconstructive operation, consequently reducing patient discomfort, length of hospital stay, and healthcare costs.
椎体切除术后辅助放疗是伤口局部并发症（如裂开、感染和皮肤坏死）的主要危险因素。在特定情况下，良好的血管化覆盖和调整伤口上的张力可能会降低术后并发症和再次手术的风险。我们旨在证明与单纯椎体切除相比，接受椎体切除和皮瓣覆盖的患者的一般和特定并发症有所减少。
我们回顾性分析并收集了2012年1月至2022年10月期间被诊断患有脊柱肿瘤且需要进行全椎板或部分后入路椎体切除术的患者的数据，这些患者均转诊至一家三级骨科和创伤中心。我们仅纳入了伤口能够一期缝合但被判定张力过大的患者。
在我们的三级创伤医院，共有145例患者因肿瘤原因接受了部分或全椎板切除术。其中，根据纳入和排除标准，最终纳入73例患者：骨科组53例，整形骨科组20例。仅考虑接受放疗的患者，整形骨科组的总体并发症发生率（33%对69%）显著低于骨科组。
一期皮瓣覆盖，尤其是在接受放疗的患者中，可降低术后并发症的风险，避免二次重建手术，从而减轻患者不适、缩短住院时间并降低医疗成本。
