- 作者：Edmund K. Bartlett ; Chelsey Meise ; Neha Bansal ; John P. Fischer ; David W. Low ; Brian J. Czerniecki ; Robert E. Roses ; Douglas L. Fraker ; Rachel R. Kelz ; Giorgos C. Karakousis
- 关键词：Sartorius transposition flap ; Inguinal lymph node dissection ; Melanoma ; Wound complication
- 刊名：Journal of Surgical Research
- 出版年：2013
- 出版时间：September, 2013
- 年：2013
- 卷：184
- 期：1
- 页码：209-215
- 全文大小：507 K
class=""h4"">Background
Inguinal lymph node dissection (ILND) for melanoma has been associated with high rates of wound complication (WC). Sartorius transposition (ST) is a technique that has been proposed to minimize morbidity. We report the frequency of utilization of ST and associated clinical outcomes in a national sample.class=""h4"">Materials and methods
Patients undergoing ILND for melanoma were identified in the American College of Surgeons National Surgical Quality Improvement Program Participant Use File (2005-2011). ST status was determined. Univariate logistic regression analyses were performed. Propensity score matching was used to control for operative time. Conditional logistic regression was used to determine the likelihood of a WC following ST in the matched cohort.
class=""h4"">Results
Of the 381 patients identified, 13 % had a WC. By univariate analysis, increasing body mass index (P = 0.006), diabetes (P = 0.02), and longer operative time (P = 0.005) were associated with WC. Sixty-three patients received a prophylactic ST (16.5 % ). ST use was significantly associated with deep nodal dissection (P = 0.03) and increased operative time (P < 0.0001) but not with any preoperative risk factors. WC rates were similar between ST and non-ST patients (10 % versus 14 % , P = 0.39). In the multivariate analysis of patients matched for operative time, ST was the only factor significantly associated with lower WC rate. The WC rate was 23 % in non-ST compared with 8 % in ST patients (P = 0.05).
class=""h4"">Conclusions
Nationally, ST is used infrequently at the time of ILND. Moreover, patients undergoing ST do not appear to be selected based on the patient factors associated with increased risk of WC. Risk factors for wound complication should be considered in the selective use of ST.