Management of complex surgical wounds of the back: identifying an evidence-based approach
Background Postoperative dehiscence and surgical site infection after spinal surgery can carry serious morbidity. Multidisciplinary involvement of plastic surgery is essential to minimizing morbidity and achieving definitive closure. However, a standardized approach is lacking. The aim of this study...
| Main Authors: | , , , , , , , |
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| Format: | Article |
| Language: | English |
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Thieme Medical Publishers, Inc.
2021-11-01
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| Series: | Archives of Plastic Surgery |
| Subjects: | |
| Online Access: | http://www.thieme-connect.de/DOI/DOI?10.5999/aps.2020.02061 |
| _version_ | 1828110438354649088 |
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| author | Elizabeth G. Zolper Meher A. Saleem Kevin G. Kim Mark D. Mishu Sarah R. Sher Christopher E. Attinger Kenneth L. Fan Karen K. Evans |
| author_facet | Elizabeth G. Zolper Meher A. Saleem Kevin G. Kim Mark D. Mishu Sarah R. Sher Christopher E. Attinger Kenneth L. Fan Karen K. Evans |
| author_sort | Elizabeth G. Zolper |
| collection | DOAJ |
| description | Background Postoperative dehiscence and surgical site infection after spinal surgery can carry serious morbidity. Multidisciplinary involvement of plastic surgery is essential to minimizing morbidity and achieving definitive closure. However, a standardized approach is lacking. The aim of this study was to identify effective reconstructive interventions for the basis of an evidence-based management protocol.
Methods A retrospective review was performed at a single tertiary institution for 45 patients who required 53 reconstruction procedures with plastic surgery for wounds secondary to spinal surgery from 2010 to 2019. Statistical analysis was performed for demographics, comorbidities, and treatment methods. Primary outcomes were postoperative complications, including dehiscence, seroma, and infection. The secondary outcome was time to healing.
Results The overall complication rate was 32%, with dehiscence occurring in 17%, seroma in 15% and infection in 11% of cases. Median follow-up was 10 months (interquartile range, 4–23). Use of antibiotic beads did not affect rate of infection occurrence after wound closure (P=0.146). Use of incisional negative pressure wound therapy (iNPWT) was significant for reduced time to healing (P=0.001). Patients treated without iNPWT healed at median of 67.5 days while the patients who received iNPWT healed in 33 days. Demographics and comorbidities between these two groups were similar.
Conclusions This data provides groundwork for an evidence-based approach to soft tissue reconstruction and management of dehiscence after spinal surgery. Timely involvement of plastic surgery in high-risk patients and utilization of evidence-based interventions such as iNPWT are essential for improving outcomes in this population. |
| first_indexed | 2024-04-11T11:19:08Z |
| format | Article |
| id | doaj.art-34490c265d45493d9a2b61d88a7b1e4c |
| institution | Directory Open Access Journal |
| issn | 2234-6163 2234-6171 |
| language | English |
| last_indexed | 2024-04-11T11:19:08Z |
| publishDate | 2021-11-01 |
| publisher | Thieme Medical Publishers, Inc. |
| record_format | Article |
| series | Archives of Plastic Surgery |
| spelling | doaj.art-34490c265d45493d9a2b61d88a7b1e4c2022-12-22T04:27:07ZengThieme Medical Publishers, Inc.Archives of Plastic Surgery2234-61632234-61712021-11-01480659960610.5999/aps.2020.020613910Management of complex surgical wounds of the back: identifying an evidence-based approachElizabeth G. Zolper0Meher A. Saleem1Kevin G. Kim2Mark D. Mishu3Sarah R. Sher4Christopher E. Attinger5Kenneth L. Fan6Karen K. Evans7Georgetown University School of Medicine, Washington, DC, USAGeorgetown University School of Medicine, Washington, DC, USADepartment of Plastic and Reconstructive Surgery, MedStar Georgetown University Hospital, Washington, DC, USAGeorgetown University School of Medicine, Washington, DC, USADepartment of Plastic and Reconstructive Surgery, MedStar Georgetown University Hospital, Washington, DC, USADepartment of Plastic and Reconstructive Surgery, MedStar Georgetown University Hospital, Washington, DC, USADepartment of Plastic and Reconstructive Surgery, MedStar Georgetown University Hospital, Washington, DC, USADepartment of Plastic and Reconstructive Surgery, MedStar Georgetown University Hospital, Washington, DC, USABackground Postoperative dehiscence and surgical site infection after spinal surgery can carry serious morbidity. Multidisciplinary involvement of plastic surgery is essential to minimizing morbidity and achieving definitive closure. However, a standardized approach is lacking. The aim of this study was to identify effective reconstructive interventions for the basis of an evidence-based management protocol. Methods A retrospective review was performed at a single tertiary institution for 45 patients who required 53 reconstruction procedures with plastic surgery for wounds secondary to spinal surgery from 2010 to 2019. Statistical analysis was performed for demographics, comorbidities, and treatment methods. Primary outcomes were postoperative complications, including dehiscence, seroma, and infection. The secondary outcome was time to healing. Results The overall complication rate was 32%, with dehiscence occurring in 17%, seroma in 15% and infection in 11% of cases. Median follow-up was 10 months (interquartile range, 4–23). Use of antibiotic beads did not affect rate of infection occurrence after wound closure (P=0.146). Use of incisional negative pressure wound therapy (iNPWT) was significant for reduced time to healing (P=0.001). Patients treated without iNPWT healed at median of 67.5 days while the patients who received iNPWT healed in 33 days. Demographics and comorbidities between these two groups were similar. Conclusions This data provides groundwork for an evidence-based approach to soft tissue reconstruction and management of dehiscence after spinal surgery. Timely involvement of plastic surgery in high-risk patients and utilization of evidence-based interventions such as iNPWT are essential for improving outcomes in this population.http://www.thieme-connect.de/DOI/DOI?10.5999/aps.2020.02061surgical wound dehiscencespinal surgerysoft tissue infectionssurgical wound infectionpostoperative care |
| spellingShingle | Elizabeth G. Zolper Meher A. Saleem Kevin G. Kim Mark D. Mishu Sarah R. Sher Christopher E. Attinger Kenneth L. Fan Karen K. Evans Management of complex surgical wounds of the back: identifying an evidence-based approach Archives of Plastic Surgery surgical wound dehiscence spinal surgery soft tissue infections surgical wound infection postoperative care |
| title | Management of complex surgical wounds of the back: identifying an evidence-based approach |
| title_full | Management of complex surgical wounds of the back: identifying an evidence-based approach |
| title_fullStr | Management of complex surgical wounds of the back: identifying an evidence-based approach |
| title_full_unstemmed | Management of complex surgical wounds of the back: identifying an evidence-based approach |
| title_short | Management of complex surgical wounds of the back: identifying an evidence-based approach |
| title_sort | management of complex surgical wounds of the back identifying an evidence based approach |
| topic | surgical wound dehiscence spinal surgery soft tissue infections surgical wound infection postoperative care |
| url | http://www.thieme-connect.de/DOI/DOI?10.5999/aps.2020.02061 |
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