Trends and measures against postoperative wound dehiscence ...
Transcript of Trends and measures against postoperative wound dehiscence ...
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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
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Disclosure
We have no potential of conflicts
of interest with this presentation
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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
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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
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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
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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
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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
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Curved skin incision (CSI)
Can the skin incision avoiding RT area decrease the wound dehiscence?
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Skin incision and exposure
Radiation therapySkin incision and exposure
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Results of CSI
16 patients
No wound dehiscence
Ecchymoma: 2 patients