Increased Rate Of Wound Complications Research Articles

Needle-tip electrocautery versus steel scalpel incision in neurosurgery: study protocol for a prospective single-centre randomised controlled double-blind trial

IntroductionElectrocautery is used widely in surgical procedures, but making skin incision has routinely been performed with scalpel rather than electrocautery, for fear that electrocautery may cause poor incision healing, excessive...

Soft Tissue Sarcomas: Is Pre-operative Radiotherapy Associated With More Acute Wound Complications?

Introduction: Increased wound complication rates are attributed to the use of pre-operative radiotherapy. The purpose of this study is to evaluate the incidence of complications with or without pre-operative radiotherapy in our institution.Methods: We retrospectively evaluated 48 adult patients with high-grade extremity soft tissue sarcoma. Twenty-two patients received pre-operative radiotherapy (group A) while 26 patients underwent initial surgery (group B). Complications were defined as major wound complications if they were severe enough to delay the delivery of adjuvant treatment (chemotherapy or radiotherapy) more than eight weeks after surgery or if their resolution required a new surgical intervention.Results: Mean follow-up in group A and group B was 44.3 and 53.8 months, respectively. The incidence of complications of any grade in group A was 45.5% and 53.8% in group B (p: 0.566). Major wound complications in group A and group B occurred in 18% and 23% of the patients (p=0.630), respectively. All patients in group A completed local treatment - radiotherapy and surgery - in 66 days on average. In contrast, in group B post-operative radiotherapy was either delayed or suspended in four patients due to wound complications. This determined that 15.4% of the patients in group B did not receive the local treatment - surgery + radiotherapy - as planned.Conclusions: An increased risk of severe acute wound complications with the administration of pre-operative radiotherapy was not observed in patients with soft tissue sarcomas of the extremities. In addition, local treatment completion was not jeopardized with preoperative radiotherapy, as opposed to post-operative radiotherapy.

The utility of the musculocutaneous anterolateral thigh flap in pharyngolaryngeal reconstruction in the high-risk patient.

Prior radiotherapy leads to increased wound complication rates for microsurgical reconstruction of pharyngolaryngeal (PL) defects. Incorporating vastus lateralis muscle together with anterolateral thigh flap (ALT) skin in defect reconstruction is useful in protecting vital structures and reinforcing irradiated neck skin and suture lines. This study shows the utility of the musculocutaneous ALT (MC ALT) in PL reconstruction in previously irradiated patients. A single-surgeon, retrospective chart review of all patients with defects of the PL region where an MC ALT was used for reconstruction from February 2014 to May 2016. The harvest of the MC ALT is described. Thirteen consecutive patients underwent reconstruction with a MC ALT flap. All 13 patients had received previous radiotherapy. PL defects included five partial, five subtotal, and three total. There was a 100% flap survival rate with five early recipient site complications including three fistulas, one neck abscess, and one partial muscle necrosis. Three patients (23%) developed strictures requiring dilatation, two of whom had received post-reconstruction radiotherapy. The use of the MC ALT for reconstruction of PL defects should be considered to mitigate the negative effects of prior irradiation and provide a back-up plan in instances where complications occur.

85IN - Innovative Combination of Targeted Agents with Radiotherapy

ABSTRACT Role of RT “in general” in STS: Radical surgery while maintaining function as much as possible is the cornerstone of extremity soft tissue sarcoma (ESTS) management. Several studies have shown that (neo-)adjuvant radiotherapy (RT) increases the probability of local control, be it at the cost of increased wound complication rates and fibrosis. Possibly only for high grade sarcomas, this gain in local control translates into a survival benefit. When not to irradiate at all: Since small ( Arguments for chemo-RT in ESTS: In many carcinomas, the addition of chemotherapy and/or smart molecules to RT has resulted in increased antitumor efficacy usually at the cost of temporary increased toxicity. The chemotherapy enhancement factor (CEF) published vary from 1.15-1.3 with conventional agents like cisplatin and 5-FU. The CEF for tyrosine kinase inhibitors is unknown. It is likely (but high levels of evidence still have to be produced) that chemo-RT in ESTS will result in comparable clinico-pathological phenomena. Ongoing and planned studies: Several sarcoma groups investigate the feasibility of combining angiogenesis inhibitors with preoperative RT. Some of these studies (Sorafenib and Bevacizumab) have already been published, others are ongoing. Given the fact, that local control after conservative surgery and RT is already high (85–93% range), it may well be that chemo-RT in ESTS offers the opportunity to lower the RT dose, while maintaining adequate local control and lowering the wound complication rate of subsequent surgery. By this means functionality of limb and quality of life after prolonged follow-up may increase. In summary: Innovative combinations of targeted agents with RT in ESTS are currently being investigated. Their future perspectives are promising, but high levels of evidence still have to be produced. Disclosure: The author has declared no conflicts of interest.