title: Quality of Life and Surgical Outcomes After Soft-Tissue Reconstruction of Complex Oncologic Defects of the Spine and Sacrum.
abstract: BACKGROUND
  Tumor-related spinal surgery has been revolutionized by recent advances in spinal stabilization, modern neuroimaging, and perioperative intensive medicine. This study examines clinical outcomes and factors associated with complications following reconstruction of complex oncologic defects of the spine and sacrum, in an attempt to increase preoperative recognition of high-risk patients with diminished wound-healing capacity and to optimize clinical outcomes in this cohort.
  
  
  METHODS
  We performed a retrospective analysis of fifty-five consecutive patients who underwent soft-tissue reconstruction with or without osseous stabilization of defects following spinal or sacral tumor resection at a quaternary referral center over a twelve-year period. Surgical outcomes included the prevalence of postoperative complications and success of wound closure at the latest follow-up. Health-related quality-of-life outcomes were assessed using the EORTC QLQ-C30 (European Organization for Research and Treatment of Cancer 30-Item Core Quality of Life Questionnaire) and SF-36 (Short Form-36) questionnaires.
  
  
  RESULTS
  The mean age of the cohort was 46.7 years (range, eighteen to seventy-one years), with a male preponderance (3:1). Soft-tissue reconstructions (n = 70 flaps) were performed in the fifty-five patients. Overall, 36.3% of patients had wound complications. There was a twofold higher wound complication rate after delayed (60%) compared with immediate (29%) reconstruction (p = 0.03). Patients undergoing delayed reconstruction reported significantly lower SF-36 and EORTC QLQ-C30 scores.
  
  
  CONCLUSIONS
  Orthoplastic management of spinal tumors should involve a strategy for preoperative recognition of patients at risk of compromised wound-healing. Prophylactic soft-tissue reconstruction can achieve stable definitive wound closure and potentially avoid the need for secondary procedures in appropriately selected patients.
  
  
  METHODS
  Prognostic Level IV. See Instructions for Authors for a complete description of levels of evidence.
authors.affiliation: Department of Plastic & Reconstructive Surgery, Nuffield Orthopaedic Hospital, Oxford University Hospitals, Oxford, United Kingdom roshdolan@hotmail.com.
authors.forename: Roisin T
authors.initials: RT
authors.lastname: Dolan
authors.affiliation: Department of Trauma & Orthopaedic Surgery, Nuffield Orthopaedic Hospital, Oxford University Hospitals, Oxford, United Kingdom.
authors.forename: Joseph S
authors.initials: JS
authors.lastname: Butler
authors.affiliation: Department of Trauma & Orthopaedic Surgery, Nuffield Orthopaedic Hospital, Oxford University Hospitals, Oxford, United Kingdom.
authors.forename: James
authors.initials: J
authors.lastname: Wilson-MacDonald
authors.affiliation: Department of Trauma & Orthopaedic Surgery, Nuffield Orthopaedic Hospital, Oxford University Hospitals, Oxford, United Kingdom.
authors.forename: Jeremy
authors.initials: J
authors.lastname: Reynolds
authors.affiliation: Department of Plastic & Reconstructive Surgery, Nuffield Orthopaedic Hospital, Oxford University Hospitals, Oxford, United Kingdom.
authors.forename: Lucy
authors.initials: L
authors.lastname: Cogswell
authors.affiliation: Department of Plastic & Reconstructive Surgery, Nuffield Orthopaedic Hospital, Oxford University Hospitals, Oxford, United Kingdom.
authors.forename: Paul
authors.initials: P
authors.lastname: Critchley
authors.affiliation: Department of Plastic & Reconstructive Surgery, Nuffield Orthopaedic Hospital, Oxford University Hospitals, Oxford, United Kingdom.
authors.forename: Henk
authors.initials: H
authors.lastname: Giele
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D015331:Cohort Studies; D005260:Female; D005500:Follow-Up Studies; D006084:Graft Rejection; D006085:Graft Survival; D006801:Humans; D008297:Male; D008875:Middle Aged; D064827:Myocutaneous Flap / Q000098:blood supply / Q000637:transplantation*; D011379:Prognosis; D011788:Quality of Life; D019651:Plastic Surgery Procedures / Q000379:methods* / Q000523:psychology; D012086:Reoperation / Q000379:methods; D012189:Retrospective Studies; D018570:Risk Assessment; D012447:Sacrum / Q000473:pathology / Q000601:surgery; D013125:Spinal Neoplasms / Q000401:mortality / Q000473:pathology / Q000523:psychology / Q000601:surgery*; D013131:Spine / Q000601:surgery*; D016019:Survival Analysis; D016896:Treatment Outcome; D014945:Wound Healing / Q000502:physiology; D055815:Young Adult