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Quality of Life and Surgical Outcomes After Soft-Tissue Reconstruction of Complex Oncologic Defects of the Spine and Sacrum

Dolan, Roisin T. MD, MRCSI1,a; Butler, Joseph S. PhD, FRCS(Tr&Orth)2; Wilson-MacDonald, James FRCS(Tr&Orth)2; Reynolds, Jeremy FRCS(Tr&Orth)2; Cogswell, Lucy FRCS(Plast)1; Critchley, Paul FRCS(Plast)1; Giele, Henk FRCS(Plast)1

Journal of Bone & Joint Surgery - American Volume: 20 January 2016 - Volume 98 - Issue 2 - p 117–126
doi: 10.2106/JBJS.N.01353
Scientific Articles

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.

Level of Evidence: Prognostic Level IV. See Instructions for Authors for a complete description of levels of evidence.

1Department of Plastic & Reconstructive Surgery, Nuffield Orthopaedic Hospital, Oxford University Hospitals, Oxford, United Kingdom

2Department of Trauma & Orthopaedic Surgery, Nuffield Orthopaedic Hospital, Oxford University Hospitals, Oxford, United Kingdom

E-mail address for R.T. Dolan: roshdolan@hotmail.com

Copyright 2016 by The Journal of Bone and Joint Surgery, Incorporated
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