Local muscle flaps minimize post-operative wound morbidity in patients with neoplastic disease of the spine

Franck, Philipp; Bernstein, Jaime L.; Cohen, Leslie E.; Härtl, Roger; Baaj, Ali A.; Spector, Jason A.

doi:10.1016/j.clineuro.2018.05.022

Cited by 19 publications

(14 citation statements)

References 27 publications

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“…6 Our complex plastic surgery closure population's complication rates were comparable or lower, despite the fact that the study population of Carl et al included fewer patients with metastatic lesions (22.6%) and had lower baseline rates of multiple major wound complication risk factors (12.2% chronic steroids, 35.3% preoperative radiation, 23.6% chemotherapy, 12.8% smoking). Another recent study of 55 patients by a group at Cornell (Franck et al 2018) reported even lower infection rates (1.7%) than our study, but similar rates of reoperation (11.7%) and seroma (15%) in an oncological population. 13 This study population also had lower baseline rates of some particularly relevant wound complication risk factors (13% diabetes, 30% smoking history).…”

Section: Discussionsupporting

confidence: 69%

“…Another recent study of 55 patients by a group at Cornell (Franck et al 2018) reported even lower infection rates (1.7%) than our study, but similar rates of reoperation (11.7%) and seroma (15%) in an oncological population. 13 This study population also had lower baseline rates of some particularly relevant wound complication risk factors (13% diabetes, 30% smoking history). It is not unexpected that rates will vary somewhat with practice group and institution.…”

Section: Discussionsupporting

confidence: 69%

“…This makes sense given the relevant background literature on musculocutaneous flap utilization in spinal wound reapproximation. [5][6][7][8][9][12][13][14]22 Moreover, our study suggests that patients with complex spinal oncology may be better treated in a multidisciplinary environment that capitalizes on the specific, unique expertise of each surgical group involved. The criteria to be used for determining need for multidisciplinary surgical care on a case-by-case basis are yet to be standardized.…”

Section: Discussionmentioning

confidence: 84%

“…Our literature review did identify known risk factors for the wound outcomes of interest. 1,2,6,9,13,19,24,26,28,29 We then grouped preoperative risk factors categorically (Table 1). Three of the four categories, including medical history factors (smoking, diabetes, hypertension, obesity), chronic medications of risk (anticoagulation, steroids), and prior cancer treatments (chemotherapy, radiation, spine surgery), comprise known preoperative medical risk factors.…”

Section: Risk Stratificationmentioning

confidence: 99%

“…These studies advocate muscle flap reconstruction as a primary closure technique for preventing infection in complex spine cases rather than exclusively as a secondary approach for reapproximating a wound after a complication has already occurred. [6][7][8][9]13,14 In June of 2015, our neurosurgery department began to increasingly involve plastic surgery in the primary closure of large spinal wounds believed to be at risk for complication after complex spine tumor resection. We now present the resultant single-institution, multisurgeon, retrospective case-control study comparing wound-related complication rates in consecutive patients who did or did not have primary plastic surgery closure of their complex posterior defect after resection of neoplastic disease.…”

mentioning

confidence: 99%

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Complex wound closure by plastic surgery following resection of spinal neoplasms minimizes postoperative wound complications in high-risk patients

Leary¹,

Liu²,

Boyajian

et al. 2020

Journal of Neurosurgery: Spine

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OBJECTIVEWound breakdown and infection are common postoperative complications following resection of spinal neoplasms. Accordingly, it has become common practice at some centers for plastic surgeons to assist with closure of large posterior defects after spine tumor resection. In this study, the authors tested the hypothesis that plastic surgery closure of complex spinal defects improves wound outcomes following resection of spinal neoplastic disease.METHODSElectronic medical records of consecutive patients who underwent resection of a spinal neoplasm between June 2015 and January 2019 were retrospectively reviewed. Patients were separated into two subpopulations based on whether the surgical wound was closed by plastic surgery or neurosurgery. Patient demographics, preoperative risk factors, surgical details, and postoperative outcomes were collected in a central database and summarized using descriptive statistics. Outcomes of interest included rates of wound complication, reoperation, and mortality. Known preoperative risk factors for wound complication in spinal oncology were identified based on literature review and grouped categorically. The presence of each category of risk factors was then compared between groups. Univariate and multivariate linear regressions were applied to define associations between individual risk factors and wound complications.RESULTSOne hundred six patients met inclusion criteria, including 60 wounds primarily closed by plastic surgery and 46 by neurosurgery. The plastic surgery population included more patients with systemic metastases (58% vs 37%, p = 0.029), prior radiation (53% vs 17%, p < 0.001), prior chemotherapy (37% vs 15%, p = 0.014), and sacral region tumors (25% vs 7%, p = 0.012), and more patients who underwent procedures requiring larger incisions (7.2 ± 3.6 vs 4.5 ± 2.6 levels, p < 0.001), prolonged operative time (413 ± 161 vs 301 ± 181 minutes, p = 0.001), and greater blood loss (906 ± 1106 vs 283 ± 373 ml, p < 0.001). The average number of risk factor categories present was significantly greater in the plastic surgery group (2.57 vs 1.74, p < 0.001). Despite the higher relative risk, the plastic surgery group did not experience a significantly higher rate of wound complication (28% vs 17%, p = 0.145), reoperation (17% vs 9%, p = 0.234), or all-cause mortality (30% vs 13%, p = 0.076). One patient died from wound-related complications in each group (p = 0.851). Regression analyses identified diabetes, multilevel instrumentation, and BMI as the factors associated with the greatest wound complications.CONCLUSIONSInvolving plastic surgery in the closure of spinal wounds after resection of neoplasms may ameliorate expected increases in wound complications among higher-risk patients.

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Section: Discussionsupporting

confidence: 69%

Section: Discussionsupporting

confidence: 69%