Background
Wound complications are well documented following spine tumor surgery due to risk factors including prior radiation therapy, poor nutritional status, and immunocompromise. Increasing evidence has shown that a multidisciplinary approach to complex oncological spine reconstruction surgery can decrease wound complication rates. The goal of this study is to assess whether plastic surgery wound closure in the setting of spine tumor surgery can lead to a decreased rate of wound complications.

Methods
A retrospective analysis of 157 consecutive patients who underwent spine tumor surgery between October 2012 and October 2022 at a Level 1 Trauma Center was performed. Clinical data regarding pre- and post-operative oncological treatment, surgical management, intra- and post-operative complications, and quality of life surveys were collected. Patients were stratified based on plastic surgery involvement in soft-tissue reconstruction and wound closure. Post-operative complications and outcomes were analyzed between groups. Statistical significance was set at p < 0.05.

Results
130 (82.8%) oncological spine surgeries underwent closure by spine surgeons (SS) and 27 (17.2%) underwent closure by plastic surgeons (PS). The PS group was 33% (N=9) female compared to 38% (N=50) female for the SS group. The PS group was younger compared to SS group (55.3 ± 18.3 vs. 62.5 ± 16.1 years; p=0.035). The PS group had a greater number of levels fused (3.3 ± 4.5 vs. 2.3 ± 2.1; p= 0.049) but a lower number of levels decompressed (1.48 ± 1.5 vs. 2.4 ± 1.2; p<0.001) compared to the SS group.

Patients in the PS group had a longer operative time (362.6 ± 278.3 vs. 225 ± 84.5 minutes; p<0.001), greater blood loss (631.8 ± 576.3 vs. 480.6 ± 454.9 mL; p=0.048), and greater length of stay (57 ± 132 vs. 10 ± 15 days; p<0.001) compared to SS group, which could be attributed to increased complexity of the PS cases. Pre-operative and post-operative Day 3 Albumin (p=0.82), Hematocrit (p=0.095), Glucose (p=0.367) and HA1c (p=0.417) had no effect on wound healing in both surgical groups. The most common coverage performed in the PS group were local paraspinal advancement flaps. The PS group had 0% post-op wound complications, wound infections, or wound-related reoperations, while the SS group had 4% (N=5) wound-related reoperations.


Conclusion
Spine tumor patients are at increased risk for impaired wound healing and post-operative wound complications. A multidisciplinary approach to oncological spine surgery, involving both spine surgeons and plastic surgeons, can improve surgical outcomes and wound healing.

Outcomes and Spine Oncology Surgery With and Without Plastic Surgery Reconstruction

 Orthopaedic Surgery

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