Trends and measures against postoperative wound dehiscence

Trends and measures against postoperative wound dehiscence after

surgery for spinal metastasis

Kakutani K1. Zhanging Z1. Yurube T1. Kakiuchi Y1. Sakai Y2. Kuroda R1.

1. Department of Orthopaedic Surgery, Kobe University Graduate School of Medicine

2. Division of Rehabilitaion Medicine, Kobe University Graduate School of Medicine

プレゼンター

プレゼンテーションのノート

この度は、このような貴重な機会を与えて頂きました会長の内尾先生、座長の労をお取りいただく土屋先生、松峰先生に深謝いたします。神戸大学の角谷です。さて、私は、脊椎転移に対する手術療法について取り組んでおりますが、その中でも最も大きな合併症であります術後創離開について傾向と私共の取り組んでおります対策について紹介させて頂きたくと思います。どうぞ、よろしくお願い申し上げます。

Disclosure

We have no potential of conflicts

of interest with this presentation

SSM

Protocol

Radiosensitive(prostate, myeloma)

Spine surgeryPVP

YesNo

Chemotherapy＋Terminal care＋Rehabilitation

Radiation therapy

Kakutani et al. Intech 2017

Symptomatic Spinal Metastasis (SSM): severe back pain or neurological deficits

プレゼンター

プレゼンテーションのノート

This is our protocol for the treatment of spinal metastasis. In this study, we called symptomatic spinal metastasis (SSM) which represents severe back pain and neurologic deficits. So, the patients with SSM should be considered to need spine surgery. In our protocol, such patient was firstly judged to undergo spine surgery or not depends on patient’s request. And then multidisciplinary treatment was performed by radiotherapist, oncologist and so on.

Radiation therapy

Pain improvement : 80%

External beam radiotherapy (EBRT)Main role of radiation therapy

Stephen L. et a. ASTRO, 2011

Acute complication (25-30%): nausea, vomit, general fatigue

Late complication (5%): radiation ulcer, vertebral fracture

83 years old male, colon cancer

Postoperative 3 months after radiation therapy for T1 metastasis

Wound dehiscence67years old female, RCC

Postoperative 17 months after radiation therapy for L2 metastasis

Patients

Average age：64.7 male: 131, female: 89

Inclusion criteriaSymptomatic spinal metastasis (SSM): severe back pain and neurological deficits

220 patients

PASW Statistics 18 (SPSS, Chicago IL)

age (>65), gender, cancer type, surgical procedure (open vs PPS), radiation therapy, PS, ADL, Chemotherapy, BMA

Logistic regression analysis

Results

Postoperative wound dehiscence : 4 patients（1.8%）

Cancer type level RT chemotherapy surgerypostoperative

(M)treatment

(M)

62 years old male

Kidney C6.7 36Gy/12Fr Sunitinib Open 3 4

83 years old male

Colon T1 30Gy/10Fr Bevacizumab Open 3 4

63 years old male

Liver C7 30Gy/10Fr Sorafenib Open 2 4

67 years old female

Kidney L2 30Gy/10Fr Sunitinib Open 15 12

No significant risk factors

Curved skin incision (CSI)

Can the skin incision avoiding RT area decrease the wound dehiscence?

Skin incision and exposure

Radiation therapySkin incision and exposure

Results of CSI

16 patients

No wound dehiscence

Ecchymoma: 2 patients

Documents

Trends and measures against postoperative wound dehiscence