Our Summary

This research paper investigates whether the involvement of plastic surgeons in closing wounds after surgery for spinal metastases (cancer that has spread to the spine) reduces the rate of complications such as wound infections and the need for reoperation. The study was conducted by reviewing the medical records of 317 patients who underwent such surgeries at a cancer center between 2013 and 2020.

The patients were divided into two groups: those whose wounds were closed by plastic surgeons (56 patients) and those whose wounds were closed by neurosurgeons (291 patients). The study found that the patients whose wounds were handled by plastic surgeons often had more challenging circumstances: they were more likely to have previously received radiation treatment, were more often undergoing long-term corticosteroid therapy, and were more likely to have tumors in the sacrococcygeal area (the lower part of the spine). These patients also had longer surgeries, lost more blood, received more transfusions, and stayed in the hospital longer.

Despite these additional challenges, the study found no significant difference in the rate of wound complications, infections, or need for reoperation between the two groups. This suggests that the use of plastic surgeons to close wounds, while perhaps beneficial for patients at high risk or with large wound defects, does not necessarily reduce the risk of complications for all patients.

FAQs

  1. Does the involvement of plastic surgeons in closing wounds after spinal metastases surgery reduce the rate of complications?
  2. What are the differences between patients whose wounds were closed by plastic surgeons and those whose wounds were closed by neurosurgeons?
  3. Does the use of plastic surgeons to close wounds reduce the risk of complications for all patients?

Doctor’s Tip

A helpful tip a doctor might tell a patient about spinal surgery is to follow post-operative instructions carefully, including proper wound care and activity restrictions, to reduce the risk of complications and promote healing. It is important to communicate with your healthcare team about any concerns or changes in your symptoms during the recovery process. Additionally, maintaining a healthy lifestyle with proper nutrition and regular exercise can help support the healing process and overall recovery.

Suitable For

Patients who are typically recommended spinal surgery include those with spinal fractures, spinal deformities (such as scoliosis), spinal stenosis (narrowing of the spinal canal), herniated discs, tumors in the spine, and spinal instability. Additionally, patients who have not responded to conservative treatments such as physical therapy, medications, and injections may also be candidates for spinal surgery. It is important for patients to undergo a thorough evaluation by a spine specialist to determine if surgery is the best course of action for their specific condition.

Timeline

Before spinal surgery:

  1. Patient experiences symptoms such as back pain, weakness, numbness, or tingling.
  2. Patient undergoes diagnostic tests such as X-rays, MRI, or CT scans to determine the cause of their symptoms.
  3. Patient consults with a neurosurgeon or orthopedic surgeon to discuss surgical options.
  4. Patient undergoes pre-operative testing and evaluation to ensure they are a suitable candidate for surgery.

After spinal surgery:

  1. Patient is admitted to the hospital for the surgical procedure.
  2. Surgery is performed to address the spinal condition, such as a laminectomy, discectomy, or spinal fusion.
  3. Patient is closely monitored in the hospital for complications such as infection, blood clots, or nerve damage.
  4. Patient undergoes physical therapy and rehabilitation to aid in recovery and regain strength and mobility.
  5. Patient follows up with their surgeon for post-operative appointments to monitor progress and address any concerns or complications.
  6. Patient gradually resumes normal activities and may experience improvements in their symptoms over time.

What to Ask Your Doctor

Some questions a patient should ask their doctor about spinal surgery include:

  1. What are the potential risks and complications associated with spinal surgery?
  2. What is the success rate of this type of surgery for my specific condition?
  3. What is the expected recovery time and rehabilitation process after spinal surgery?
  4. Will I need physical therapy or other treatments after surgery?
  5. What are the alternative treatment options to surgery for my condition?
  6. How many times have you performed this type of surgery, and what is your success rate?
  7. Will I need to see a plastic surgeon for wound closure after surgery, and if so, how will this impact my recovery?
  8. What are the long-term outcomes and potential complications I should be aware of?
  9. How will my pain be managed after surgery?
  10. Are there any lifestyle changes or precautions I should take after spinal surgery?

Reference

Authors: Hersh AM, Pennington Z, Schilling AT, Porras J, Hung B, Antar A, Patel J, Lubelski D, Feghali J, Goodwin CR, Lo SL, Sciubba DM. Journal: Clin Neurol Neurosurg. 2021 Aug;207:106800. doi: 10.1016/j.clineuro.2021.106800. Epub 2021 Jul 9. PMID: 34280676