Risk Factors for Significant Wound Complications Following Wide Resection of Extremity Soft Tissue Sarcomas
Risk Factors for Significant Wound Complications Following Wide Resection of Extremity Soft Tissue Sarcomas
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DOI：
10.1007/s11999-013-3130-4
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发表时间：
2013-11-01
影响因子：
4.2
通讯作者：
Beauchamp, Christopher
中科院分区：
文献类型：
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作者：
Schwartz, Adam;Rebecca, Alanna;Beauchamp, Christopher
局部软组织肉瘤切除术后的伤口并发症与下肢位置、肿瘤体积大和术前放疗有关。然而，其中一些伤口显示出通过局部伤口护理和非手术技术愈合的潜力。我们不知道任何已发表的数据建立与最终采用局部或游离血管化组织移植治疗的不愈合伤口相关的因素。本研究的目的是确定与严重伤口并发症发展相关的变量，严重伤口并发症定义为在切除局部软组织肉瘤后采用局部或游离组织移植进行二次手术。数据库中，我们确定了140例患者谁接受了局部肢体软组织肉瘤切除术在我们的机构在1997年和2010年之间。排除了32例接受立即计划血管化组织移植的患者，沿着排除了26例未接受放射治疗的患者，另外排除了3例随访不到1个月的患者。剩下79例患者，其中18例接受术后外照射放疗，61例接受术前外照射放疗。在术前接受放射治疗的患者中，13例未接受额外的放射治疗，33例接受术中电子放射（IOERT）治疗局部复发高风险部位，另外15例接受围手术期近距离放射治疗。单变量和多元回归分析使用频率的局部或游离组织转移在3周或更长时间后，由于伤口相关的并发症作为一个因变量。下肢位置和血管受累与使用延迟血管化组织覆盖伤口愈合问题。本系列中接受术前外照射放疗联合剂量-加强IOERT或化疗与术后放射治疗的患者相比，皮瓣使用率相似。对于下肢肿瘤累及主要神经血管结构并计划进行放射治疗的患者，应特别建议，因为他们使用延迟的局部或游离血管组织的风险似乎增加局部肢体软组织肉瘤切除后的不愈合伤口的转移。
Wound complications following resection of a localized soft tissue sarcoma have been associated with lower extremity location, large tumor volume, and use of preoperative radiation. Some of these wounds, however, show the potential for healing with local wound care and nonsurgical techniques. We are unaware of any published data establishing factors associated with nonhealing wounds that ultimately are treated with local or free vascularized tissue transfer.The purpose of this study was to determine the variables associated with development of a significant wound complication defined as one that underwent a secondary procedure using local or free tissue transfer after resection of a localized soft tissue sarcoma.Using our institution's cancer center database, we identified 140 patients who underwent resection of a localized extremity soft tissue sarcoma at our institution between 1997 and 2010. Thirty-two patients were excluded who underwent immediate planned vascularized tissue transfer, along with 26 patients who did not receive radiation, and an additional three patients were excluded who were followed for less than 1 month. This left 79 patients, including 18 treated with postoperative external beam radiotherapy and 61 with preoperative external beam radiotherapy. Of patients receiving radiation treatment before surgery, 13 received no additional radiation treatment, 33 underwent intraoperative radiation with electrons (IOERT) to sites considered at high risk for local recurrence, and an additional 15 had perioperative brachytherapy. Univariate and multiple regression analyses were performed using frequency of local or free tissue transfer at 3 weeks or greater postoperatively owing to wound-related complications as a dependent variable.Lower extremity location and vascular involvement were associated with use of delayed vascularized tissue coverage for wound-healing problems. Patients in this series who underwent preoperative external beam radiotherapy coupled with dose-escalated IOERT or chemotherapy had a similar rate of flap use compared with patients treated with postoperative radiation.Patients with tumors of the lower extremity involving major neurovascular structures and for whom radiation therapy is planned should be counseled specifically because they appear to be at increased risk for use of delayed local or free vascularized tissue transfer for a nonhealing wound following resection of a localized extremity soft tissue sarcoma.