Department of Surgery, MS 133, St. Jude Children's Research Hospital, 262 Danny Thomas Place, Memphis, TN, 38105, USA.
Department of Surgery, MS 133, St. Jude Children's Research Hospital, 262 Danny Thomas Place, Memphis, TN, 38105, USA; Department of Surgical Oncology, National Cancer Institute, Cairo University, Egypt.
J Pediatr Surg. 2024 Sep;59(9):1735-1739. doi: 10.1016/j.jpedsurg.2024.02.028. Epub 2024 Mar 5.
Limb-sparing surgery is the standard of care for primary bone tumors. However, such procedures are associated with high rates of wound complications, specifically in lower-extremity surgeries. Therefore, identifying and implementing interventions to minimize the likelihood of wound complications after limb-sparing resection of the lower extremity is crucial.
Patients who underwent limb-sparing osteosarcoma or Ewing sarcoma resection during a 7-year period at a single institution were retrospectively reviewed. Data were collected on 39 patients who underwent limb-sparing resection of the femur. Patient demographics, tumor characteristics, and perioperative and postoperative data were extracted and analyzed. Patients who underwent resection before April 2017 received conventional postoperative incision dressings. Starting in April 2017, patients received vacuum-assisted closure (VAC) with the 3 M™ Prevena VAC system after surgical closure. Eighteen patients received conventional postoperative incision dressing, and 21 received incisional wound VAC. A wound complication was defined as any Clavien-Dindo classification greater than 0 within a 28-day postoperative period.
Patients who received postoperative incisional wound VAC had lower rates of wound complications than those who received conventional incision dressings (14% vs. 50%; p = 0.035). Additionally, patients in whom wound complications developed had a longer average hospital stay than those without wound complications (5 days vs. 4 days; p = 0.029).
Wound complications prolong the hospital stay and can delay adjuvant chemotherapy for bone tumors. The use of postoperative incisional wound VAC is associated with less likelihood of wound complications and should be considered in any high-risk surgical closure.
Level III Treatment Study.
保肢手术是原发性骨肿瘤的标准治疗方法。然而，此类手术与高伤口并发症率相关，特别是在下肢手术中。因此，确定并实施干预措施以最大程度地降低下肢保肢切除术后发生伤口并发症的可能性至关重要。
对一家机构 7 年内进行的保肢骨肉瘤或尤因肉瘤切除术患者进行回顾性分析。对 39 例行股骨保肢切除术的患者的数据进行了收集。提取并分析了患者的人口统计学资料、肿瘤特征以及围手术期和术后数据。2017 年 4 月前接受常规术后切口敷料的患者为对照组，2017 年 4 月后接受真空辅助闭合（VAC）治疗的患者为观察组。对照组 18 例患者接受常规术后切口敷料，观察组 21 例患者接受切口 VAC。术后 28 天内出现任何 Clavien-Dindo 分级大于 0 的伤口并发症定义为伤口并发症。
观察组患者的伤口并发症发生率低于对照组（14% vs. 50%；p = 0.035）。此外，发生伤口并发症的患者平均住院时间长于未发生伤口并发症的患者（5 天 vs. 4 天；p = 0.029）。
伤口并发症会延长住院时间，并可能延迟骨肿瘤的辅助化疗。术后切口 VAC 的使用与较低的伤口并发症发生率相关，在任何高风险的手术缝合中都应考虑使用。
III 级治疗研究。
