Reconstructive strategies in soft tissue reconstruction after resection of spinal neoplasms.
METHODS
A retrospective study of 134 consecutive cases in 92 patients who underwent soft tissue reconstruction of the spinal region following tumor removal.


OBJECTIVE
To better understand how to optimize outcomes in soft tissue reconstruction of the spine region.


BACKGROUND
With the increasing use of instrumentation and the fact that many patients with spinal neoplasms have debilitated wound-healing capacity, most of these patients are at high risk for postsurgical wound complications. Unfortunately, the optimal strategy to prevent and to manage complex wound complications involving the spinal region remains unclear.


METHODS
Factors potentially associated with the outcome of the reconstruction, including previous radiation therapy, chemotherapy, or surgery; medical comorbidities; timing of the reconstructive surgery; location of the defect; reconstructive approach; and presence of instrumentation, were evaluated and compared.


RESULTS
Of 92 patients, 29 patients (32%) developed postoperative wound complications. Among 32 patients with instrumentation of the spine, the 10 patients who had prophylactic soft tissue reconstruction had a significantly lower incidence of complications than did the 22 patients who had not (20% vs. 45%, P = 0.018). Furthermore, those who had previous surgery to the spine had a significantly higher risk of developing exposed instrumentation than did those who did not (21% vs. 0%, P = 0.002). Of 9 patients with exposed instrumentation, all but 1 patient had successful coverage of the instrumentation. Ninety (98%) of 92 patients had successful closure of the wound at the time of their last follow-up.


CONCLUSIONS
In the presence of instrumentation, providing preemptive soft tissue reconstruction at the time of the initial spinal surgery can help minimize potentially serious wound complications. For management of wound complications that have developed, an aggressive debridement and coverage with well-vascularized tissue can allow for expedient wound healing while maintaining stabilized instrumentation.
Chang
David W
DW
Department of Plastic Surgery, University of Texas M. D. Anderson Cancer Center, Houston, TX 77030-4009, USA. dchang@mdanderson.org
Friel
Michael T
MT
Youssef
Adel A
AA
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002648:Child; D002675:Child, Preschool; D002813:Chondrosarcoma / Q000453:epidemiology / Q000601:surgery; D002817:Chordoma / Q000453:epidemiology / Q000601:surgery; D005260:Female; D006801:Humans; D007223:Infant; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D012516:Osteosarcoma / Q000453:epidemiology / Q000601:surgery; D011183:Postoperative Complications / Q000453:epidemiology*; D019651:Plastic Surgery Procedures / Q000295:instrumentation / Q000379:methods / Q000706:statistics & numerical data*; D012189:Retrospective Studies; D012307:Risk Factors; D012509:Sarcoma / Q000453:epidemiology* / Q000601:surgery*; D013125:Spinal Neoplasms / Q000453:epidemiology* / Q000601:surgery*; D013524:Surgical Flaps; D014945:Wound Healing