Predictors of complications and outcomes of external hemipelvectomy wounds: Account of 160 consecutive cases

Alex Senchenkov, Steven Lawrence Moran, Paul M. Petty, James Knoetgen, Ricky P. Clay, Uldis Bite, Sunni A. Barnes, Franklin H. Sim

Research output: Contribution to journalArticle

50 Citations (Scopus)

Abstract

Background: Hemipelvectomy has high wound complication rates. This study aimed to determine variables that may influence hemipelvectomy wound morbidity. Methods: The records of 160 consecutive hemipelvectomy patients were reviewed with a focus on demographics, treatment, and surgical techniques. Multivariate analysis was used to determine risk factors for postoperative hemipelvectomy wound infection and flap necrosis. Results: There were 31 standard, 62 modified, and 67 extended hemipelvectomy patients in whom 19 contiguous visceral, 62 spinal, 4 contralateral pelvic resections, and 1 contralateral hemipelvectomy were performed. Hospital mortality rate was 5%, and overall morbidity was 54%. Wound complications such as infection (39%) and flap necrosis (26%) were the most common. For modified, standard, and extended hemipelvectomies, rates of wound infection were 29%, 34%, and 51% (P = .036) and rates of flap necrosis were 16%, 25%, and 35% (P = .046), respectively. Longer operative time and increased complexity were associated with higher wound infection and flap necrosis rates. The hemipelvectomy flap design did not influence the frequency of wound infection (P = .173) or flap necrosis (P = .098). Common iliac vessel ligation was the most statistically significant predictor of flap necrosis and was associated with the 2.7-fold increase in flap necrosis rate (P = .001) in patients undergoing posterior flap hemipelvectomy. Conclusions: External hemipelvectomy has low mortality but high morbidity. Postoperative wound infection and flap necrosis are multifactorial events related to length and extent of operation. Level of vascular ligation strongly influenced flap necrosis rate for posterior flap hemipelvectomy.

Original languageEnglish (US)
Pages (from-to)355-363
Number of pages9
JournalAnnals of Surgical Oncology
Volume15
Issue number1
DOIs
StatePublished - Jan 2008

Fingerprint

Hemipelvectomy
Necrosis
Wounds and Injuries
Wound Infection
Surgical Wound Infection
Morbidity
Ligation
Mortality
Operative Time
Hospital Mortality
Blood Vessels

Keywords

  • Flap necrosis
  • Flaps
  • Hemipelvectomy
  • Operative technique
  • Pelvic reconstruction
  • Pelvic vessel ligation
  • Pelvic wound complications
  • Wound infection

ASJC Scopus subject areas

  • Surgery
  • Oncology

Cite this

Predictors of complications and outcomes of external hemipelvectomy wounds : Account of 160 consecutive cases. / Senchenkov, Alex; Moran, Steven Lawrence; Petty, Paul M.; Knoetgen, James; Clay, Ricky P.; Bite, Uldis; Barnes, Sunni A.; Sim, Franklin H.

In: Annals of Surgical Oncology, Vol. 15, No. 1, 01.2008, p. 355-363.

Research output: Contribution to journalArticle

Senchenkov, Alex ; Moran, Steven Lawrence ; Petty, Paul M. ; Knoetgen, James ; Clay, Ricky P. ; Bite, Uldis ; Barnes, Sunni A. ; Sim, Franklin H. / Predictors of complications and outcomes of external hemipelvectomy wounds : Account of 160 consecutive cases. In: Annals of Surgical Oncology. 2008 ; Vol. 15, No. 1. pp. 355-363.
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abstract = "Background: Hemipelvectomy has high wound complication rates. This study aimed to determine variables that may influence hemipelvectomy wound morbidity. Methods: The records of 160 consecutive hemipelvectomy patients were reviewed with a focus on demographics, treatment, and surgical techniques. Multivariate analysis was used to determine risk factors for postoperative hemipelvectomy wound infection and flap necrosis. Results: There were 31 standard, 62 modified, and 67 extended hemipelvectomy patients in whom 19 contiguous visceral, 62 spinal, 4 contralateral pelvic resections, and 1 contralateral hemipelvectomy were performed. Hospital mortality rate was 5{\%}, and overall morbidity was 54{\%}. Wound complications such as infection (39{\%}) and flap necrosis (26{\%}) were the most common. For modified, standard, and extended hemipelvectomies, rates of wound infection were 29{\%}, 34{\%}, and 51{\%} (P = .036) and rates of flap necrosis were 16{\%}, 25{\%}, and 35{\%} (P = .046), respectively. Longer operative time and increased complexity were associated with higher wound infection and flap necrosis rates. The hemipelvectomy flap design did not influence the frequency of wound infection (P = .173) or flap necrosis (P = .098). Common iliac vessel ligation was the most statistically significant predictor of flap necrosis and was associated with the 2.7-fold increase in flap necrosis rate (P = .001) in patients undergoing posterior flap hemipelvectomy. Conclusions: External hemipelvectomy has low mortality but high morbidity. Postoperative wound infection and flap necrosis are multifactorial events related to length and extent of operation. Level of vascular ligation strongly influenced flap necrosis rate for posterior flap hemipelvectomy.",
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T1 - Predictors of complications and outcomes of external hemipelvectomy wounds

T2 - Account of 160 consecutive cases

AU - Senchenkov, Alex

AU - Moran, Steven Lawrence

AU - Petty, Paul M.

AU - Knoetgen, James

AU - Clay, Ricky P.

AU - Bite, Uldis

AU - Barnes, Sunni A.

AU - Sim, Franklin H.

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N2 - Background: Hemipelvectomy has high wound complication rates. This study aimed to determine variables that may influence hemipelvectomy wound morbidity. Methods: The records of 160 consecutive hemipelvectomy patients were reviewed with a focus on demographics, treatment, and surgical techniques. Multivariate analysis was used to determine risk factors for postoperative hemipelvectomy wound infection and flap necrosis. Results: There were 31 standard, 62 modified, and 67 extended hemipelvectomy patients in whom 19 contiguous visceral, 62 spinal, 4 contralateral pelvic resections, and 1 contralateral hemipelvectomy were performed. Hospital mortality rate was 5%, and overall morbidity was 54%. Wound complications such as infection (39%) and flap necrosis (26%) were the most common. For modified, standard, and extended hemipelvectomies, rates of wound infection were 29%, 34%, and 51% (P = .036) and rates of flap necrosis were 16%, 25%, and 35% (P = .046), respectively. Longer operative time and increased complexity were associated with higher wound infection and flap necrosis rates. The hemipelvectomy flap design did not influence the frequency of wound infection (P = .173) or flap necrosis (P = .098). Common iliac vessel ligation was the most statistically significant predictor of flap necrosis and was associated with the 2.7-fold increase in flap necrosis rate (P = .001) in patients undergoing posterior flap hemipelvectomy. Conclusions: External hemipelvectomy has low mortality but high morbidity. Postoperative wound infection and flap necrosis are multifactorial events related to length and extent of operation. Level of vascular ligation strongly influenced flap necrosis rate for posterior flap hemipelvectomy.

AB - Background: Hemipelvectomy has high wound complication rates. This study aimed to determine variables that may influence hemipelvectomy wound morbidity. Methods: The records of 160 consecutive hemipelvectomy patients were reviewed with a focus on demographics, treatment, and surgical techniques. Multivariate analysis was used to determine risk factors for postoperative hemipelvectomy wound infection and flap necrosis. Results: There were 31 standard, 62 modified, and 67 extended hemipelvectomy patients in whom 19 contiguous visceral, 62 spinal, 4 contralateral pelvic resections, and 1 contralateral hemipelvectomy were performed. Hospital mortality rate was 5%, and overall morbidity was 54%. Wound complications such as infection (39%) and flap necrosis (26%) were the most common. For modified, standard, and extended hemipelvectomies, rates of wound infection were 29%, 34%, and 51% (P = .036) and rates of flap necrosis were 16%, 25%, and 35% (P = .046), respectively. Longer operative time and increased complexity were associated with higher wound infection and flap necrosis rates. The hemipelvectomy flap design did not influence the frequency of wound infection (P = .173) or flap necrosis (P = .098). Common iliac vessel ligation was the most statistically significant predictor of flap necrosis and was associated with the 2.7-fold increase in flap necrosis rate (P = .001) in patients undergoing posterior flap hemipelvectomy. Conclusions: External hemipelvectomy has low mortality but high morbidity. Postoperative wound infection and flap necrosis are multifactorial events related to length and extent of operation. Level of vascular ligation strongly influenced flap necrosis rate for posterior flap hemipelvectomy.

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KW - Flaps

KW - Hemipelvectomy

KW - Operative technique

KW - Pelvic reconstruction

KW - Pelvic vessel ligation

KW - Pelvic wound complications

KW - Wound infection

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