Department of Orthopedics and Rehabilitation, University of Iowa Hospitals and Clinics, Iowa City, Iowa, USA.
Iowa Orthop J. 2023 Dec;43(2):45-51.
Wound healing is particularly important for sarcoma patients who undergo neoadjuvant radiation therapy. Previous studies have demonstrated wound complications in this population approaching 35%. With this high rate of wound healing issues, identifying treatment modalities to minimize these complications is of paramount importance.
All patients with high grade bone and soft tissue sarcoma received 15 days of twice daily amino acid supplementation starting in the immediate post-operative period. We documented the healing status of the surgical wound, the primary outcome, at all follow up appointments until six months after surgery. Non-healing wounds were defined as any wound requiring 1) a return visit to the OR for debridement, 2) IV antibiotics (ABX), and 3) unhealed wounds at 6 months post-operatively. For each patient, we collected biometrics with lean body mass analysis at preoperative appointment, and two and six weeks postoperatively. The proportion with non-healing wounds was compared with a historical patient cohort using the chi-square test. In a subgroup of participants with body composition measurements, we also compared changes in mean fat mass, lean mass, and psoas index from pre-operative baseline to 6 months post-operative using generalized linear models.
A total of 33 consecutive patients were supplemented with a branched chain amino acid (BCAA) formulation. The historical cohort included 146 participants from the previous 7 years (2010-2017). 26% of patients in the historical cohort experienced wound complications compared to 30% in the supplemented group. (p=0.72) When focusing specifically on lower extremity sarcomas treated with neoadjuvant radiation therapy, 46% of patients in the supplemented group experienced wound healing complications compared to 39% in the non-supplemented group (p=0.68). BCAA supplementation was found to be protective with regards to decreasing muscle wasting with no difference in psoas index measurements throughout the study period compared to a 20% muscle loss in the historical cohort (p=0.02).
In our limited sample size, there was no difference in wound healing complications between sarcoma patients who received postoperative BCAA supplementation compared to a historical cohort who were not supplemented. Patients who did not receive supplementation had a significant decline in post-operative psoas index following operative sarcoma removal. .
新辅助放疗后的肉瘤患者尤其需要伤口愈合。既往研究表明，该人群的伤口并发症接近 35%。鉴于伤口愈合问题发生率较高，确定能最大程度减少这些并发症的治疗方法至关重要。
所有高级别骨和软组织肉瘤患者均在术后即刻开始接受为期 15 天的每日两次氨基酸补充治疗。我们在所有随访预约中记录手术伤口的愈合情况（主要结局），直至术后 6 个月。未愈合的伤口定义为以下任何一种伤口：1）需要返回手术室清创；2）需要静脉使用抗生素（ABX）；3）术后 6 个月仍未愈合。对于每位患者，我们在术前预约、术后 2 周和 6 周收集生物统计学数据，包括瘦体重分析。使用卡方检验比较未愈合伤口的患者比例与历史患者队列。在有身体成分测量的亚组参与者中，我们还使用广义线性模型比较了从术前基线到术后 6 个月时平均脂肪量、瘦体重和腰大肌指数的变化。
共 33 例连续患者接受了支链氨基酸（BCAA）配方补充。历史队列包括过去 7 年（2010-2017 年）的 146 名患者。历史队列中有 26%的患者发生伤口并发症，补充组中有 30%的患者发生（p=0.72）。当专门关注接受新辅助放疗的下肢肉瘤患者时，补充组中有 46%的患者发生伤口愈合并发症，而未补充组中有 39%的患者发生（p=0.68）。与历史队列相比，BCAA 补充组在整个研究期间肌肉减少量没有差异，且腰大肌指数测量结果保持不变（p=0.02）。
在我们的有限样本量中，接受术后 BCAA 补充的肉瘤患者与未接受补充的历史队列相比，伤口愈合并发症无差异。未接受补充的患者在接受肉瘤切除术后，其腰大肌指数显著下降。
