Schewe Simone, Sagebiel Adrian, Wakker Jonas, Voss Nina, Al Shonikat Ruba, Priemel Matthias, Reiter Alonja, Striefler Jana, Blessmann Marco, Hackert Thilo, Duprée Anna
Department of General, Visceral, and Thoracic Surgery, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.
Clinic and Polyclinic for Trauma Surgery and Orthopedics, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.
Langenbecks Arch Surg. 2025 Sep 25;410(1):277. doi: 10.1007/s00423-025-03865-8.
In sarcomas, surgery is an essential component of therapy. Depending on their location, sarcomas can reach a considerable size, which increases the risk of wound complications (WC) after resections. This often results in longer hospital stays and thus delays further oncological treatment. Therefore, reducing WCs is indispensable for improving treatment. The VAC (Vacuum-Assisted Closure) therapy has been shown to have a positive effect on wound healing, but there are limited studies for its use after sarcoma resections. The aim of this study was to analyze the outcomes of various wound closure techniques. This was intended to identify optimal wound care to prevent WCs and to determine risk factors for complications.
This study is a single-center study that included all patients who underwent surgery for sarcomas of the body surface and extremities. A retrospective data analysis was conducted for the years 2021-2023. The primary endpoint was the development of wound complications. Here, primary wound closure was compared with secondary closure after negative wound pressure therapy (NWPT). Secondary endpoints included the impact of drains, subtype, location, and comorbidities.
A total of 211 patients were examined. The most common histological subtype was liposarcoma (32,88%), followed by undifferentiated sarcoma (19,18%). Wound complications occurred in 30,19% of all cases. The analysis showed that 40,4% of patients with primary wound closure developed a complication, while only 20% of patients with NWPT did. A significant risk factor for the development of a WC was a tumor diameter > 10 cm, which led to a 20,13% higher risk of infection compared to smaller tumors. 68.3% of wound complications occurred in the lower extremity. Additionally, neoadjuvant therapy, longer operation time and immunosuppression were detected as risk factors for a higher complication rate.
This study highlights the significantly increased risk of WCs in large sarcomas of the lower extremities. VAC therapy showed a significant improvement in wound closure especially in high-risk cases. Based on the results, the use of NWPT can be essential for wound management in sarcomas and improve convalescence and oncological treatment.
在肉瘤治疗中，手术是重要的治疗组成部分。根据其位置，肉瘤可能长得相当大，这会增加切除术后伤口并发症（WC）的风险。这通常会导致住院时间延长，从而延误进一步的肿瘤治疗。因此，减少伤口并发症对于改善治疗至关重要。负压封闭引流（VAC）疗法已被证明对伤口愈合有积极作用，但关于其在肉瘤切除术后应用的研究有限。本研究的目的是分析各种伤口闭合技术的结果。这旨在确定预防伤口并发症的最佳伤口护理方法，并确定并发症的风险因素。
本研究是一项单中心研究，纳入了所有接受体表和四肢肉瘤手术的患者。对2021年至2023年的数据进行了回顾性分析。主要终点是伤口并发症的发生情况。在此，将一期伤口闭合与负压伤口治疗（NWPT）后的二期闭合进行比较。次要终点包括引流管、亚型、位置和合并症的影响。
共检查了211例患者。最常见的组织学亚型是脂肪肉瘤（32.88%），其次是未分化肉瘤（19.18%）。所有病例中伤口并发症发生率为30.19%。分析表明，一期伤口闭合的患者中有40.4%发生了并发症，而接受NWPT的患者中只有20%发生了并发症。伤口并发症发生的一个显著风险因素是肿瘤直径>10 cm，与较小肿瘤相比，感染风险高20.13%。68.3%的伤口并发症发生在下肢。此外，新辅助治疗、手术时间延长和免疫抑制被检测为并发症发生率较高的风险因素。
本研究强调了下肢大型肉瘤伤口并发症风险显著增加。VAC疗法在伤口闭合方面显示出显著改善，尤其是在高危病例中。根据结果，NWPT的应用对于肉瘤伤口管理至关重要，可改善康复和肿瘤治疗。
