Review Question - QID 211641

Patients undergoing revision spine tumor surgery have improved outcomes with immediate closure as compared to delayed soft tissue reconstruction.

Patients with metastatic disease undergoing revision surgery have improved wound outcomes when immediate soft tissue reconstruction is performed. Risk factors for wound complications include previous smoking, irradiation, use of instrumentation, and revision surgery. In these patients wound complications can be disastrous, and preventive measures should be undertaken. Delayed soft tissue reconstruction has a two-fold higher wound complication rate compared to immediate reconstruction.

Mesfin et al performed a systematic review looking at factors for wound complications and methods of prevention in cases of metastatic tumor spine surgery. They found wound complication risk factors included preoperative radiation, preoperative neurologic injury, revision procedures, and posterior approaches. Preventive measures identified included plastic surgery soft tissue reconstruction, intrawound vancomycin powder, and percutaneous pedicle screw fixation. They strongly recommend that plastic surgery performs soft tissue reconstruction in revision metastatic spine tumor surgery.

Dolan et al compared outcomes in treatment with immediate versus delayed soft tissue reconstruction in spine tumor patients. They had 55 patient that underwent 70 soft tissue reconstructive surgeries (flaps). The overall complication rate was 36.3%, however wound complication was 60% in the delayed reconstruction group compared to 29% in the immediate reconstruction group. Additionally, the delayed group has significantly lower outcome scores. They recommend performing immediate soft tissue reconstructive surgery in these patients.

Incorrect Answers:
Answer 1, 3, and 5: These have all been shown to be risk factors for postoperative wound complications.
Answer 2: Greater than 6 levels of surgery is a risk factor for instrumentation failure.