Predictors of soft‐tissue complications and deep infection in allograft reconstruction of the proximal tibia

Lozano-Calderón, Santiago; Swaim, Sara O.; Federico, Amy; Anderson, Megan E.; Gebhardt, Mark C.

doi:10.1002/jso.24234

Cited by 31 publications

(25 citation statements)

References 19 publications

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“…While autologous bone grafting is currently the gold standard therapeutic strategy, such a procedure has many drawbacks. For example, there is a limited supply of autologous bone, additional surgery is needed which leads to donor site morbidity, and the associated risk of infection [ 33 , 88 ]. Since alternative approaches are highly sought after, MSC-based bone regeneration has been explored [ 33 , 89 ].…”

Section: The Effect Of Substrate Topographymentioning

confidence: 99%

Topography: A Biophysical Approach to Direct the Fate of Mesenchymal Stem Cells in Tissue Engineering Applications

Cun

Hosta‐Rigau

2020

Nanomaterials

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Tissue engineering is a promising strategy to treat tissue and organ loss or damage caused by injury or disease. During the past two decades, mesenchymal stem cells (MSCs) have attracted a tremendous amount of interest in tissue engineering due to their multipotency and self-renewal ability. MSCs are also the most multipotent stem cells in the human adult body. However, the application of MSCs in tissue engineering is relatively limited because it is difficult to guide their differentiation toward a specific cell lineage by using traditional biochemical factors. Besides biochemical factors, the differentiation of MSCs also influenced by biophysical cues. To this end, much effort has been devoted to directing the cell lineage decisions of MSCs through adjusting the biophysical properties of biomaterials. The surface topography of the biomaterial-based scaffold can modulate the proliferation and differentiation of MSCs. Presently, the development of micro- and nano-fabrication techniques has made it possible to control the surface topography of the scaffold precisely. In this review, we highlight and discuss how the main topographical features (i.e., roughness, patterns, and porosity) are an efficient approach to control the fate of MSCs and the application of topography in tissue engineering.

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Section: The Effect Of Substrate Topographymentioning

confidence: 99%

Topography: A Biophysical Approach to Direct the Fate of Mesenchymal Stem Cells in Tissue Engineering Applications

Cun

Hosta‐Rigau

2020

Nanomaterials

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“…Lozano-Calderón et al reported another series of 33 pediatric tibia sarcomas treated with allograft reconstruction. e wound dehiscence rate was 48%, with all but one patient requiring irrigation and debridement [6]. A large Sarcoma cohort of 121 pediatric and adult bone and soft tissue sarcomas from Peel et al also reported high rates of infectious complications with 16% of patients developing early postoperative bacteremia and 14% of patients developing a tumor endoprosthesis infection [9].…”

Section: Sarcomamentioning

confidence: 99%

“…Surgery is frequently used to obtain local control in patients with tumors amenable to resection, and there have been numerous advances in surgical techniques, imaging modalities, and adjuvant therapies leading to improvements in survival and functional outcomes [2][3][4]. Due to the rare incidence of these tumors, past research has frequently been limited to case series and small sample sizes [5][6][7][8][9].…”

Section: Introductionmentioning

confidence: 99%

Thirty-Day Outcomes following Pediatric Bone and Soft Tissue Sarcoma Surgery: A NSQIP Pediatrics Analysis

Gallaway

Ahn

Callan

2020

Sarcoma

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Background. Pediatric bone and soft tissue sarcomas are rare; therefore, national registries are essential tools for orthopedic oncology research. Past studies provide excellent data on long-term prognosis and survival trends but fail to examine treatment-specific morbidity. The aim of this study is to use a national registry to describe patient demographics, comorbidities, and adverse events in the first thirty days following surgical management of pediatric bone and soft tissue sarcomas. Methods. A retrospective review of patients in the American College of Surgeons National Surgical Quality Improvement Program—Pediatrics database (NSQIP-P) was performed. The cohort was partitioned by tumor origin (bone versus soft tissue) and tumor location (axial versus appendicular). Results. One-hundred ninety-two patients were identified. Bone sarcomas were more common (71.9%) and predominately appendicular (62.3%), while soft tissue sarcomas were predominately axial (77.8%). The overall complication rate was 8.9%. The most frequent etiologies were wound dehiscence (3.6%) and infectious complications such as surgical site infections (2.6%), pneumonia (1.6%), urinary tract infections (1.6%), and C. diff colitis (1.0%). Twenty-four percent of patients experienced bleeding requiring transfusion. The unplanned readmission rate was 12.5% (3.6% related to principle procedure), and the unplanned reoperation rate was 4.7% (4.2% related to principle procedure). The mortality rate was 1.0%. Neoadjuvant chemotherapy was associated with higher rates of wound dehiscence and infectious complications. There were no differences in adverse events with respect to tumor origin or location. Conclusion. Approximately 1 in 11 pediatric patients will experience a complication in the first thirty days following surgery. However, perioperative mortality remains low. This study represents the first comprehensive review of pediatric bone and soft tissue sarcoma surgery in the NSQIP-P database. As the case volume of NSQIP-P continues to grow, NSQIP-P has the potential to become a powerful tool for pediatric orthopedic oncology research.

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“…Abnormal body mass index (BMI) has been found to be associated with worse survival in Ewing's sarcoma and with postoperative infections in osteosarcoma . Additionally, high BMI and low white blood cell (WBC) count have been implicated as potential predictors of deep infection in allograft reconstructions . However, BMI and WBC count represent variables that are difficult to modify for patients with bone sarcomas.…”

Section: Introductionmentioning

confidence: 99%

“…5,6 Additionally, high BMI and low white blood cell (WBC) count have been implicated as potential predictors of deep infection in allograft reconstructions. 7 However, BMI and WBC count represent variables that are difficult to modify for patients with bone sarcomas. Whether modifiable risk factors that can be readily optimized before surgeries for bone sarcomas exist is unknown.…”

Section: Introductionmentioning

confidence: 99%

Is malnutrition associated with postoperative complications in patients with primary bone sarcomas?

Park

Lans

Raskin

et al. 2018

Journal of Surgical Oncology

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Background Modifiable risk factors that can be optimized to minimize postoperative complications in patients with bone sarcomas are yet to be identified. Methods We retrospectively identified 275 patients aged 18 and older who underwent surgery for primary bone sarcomas who also had albumin values recorded within 4 weeks before surgery. Postoperative complications were defined as infection, hematoma, need for additional surgery, or wound complications. Results In the multivariate analysis, age (P = 0.049) and neoadjuvant radiotherapy (P = 0.008) were independently associated with postoperative complications. We then performed a subanalysis of patients without a pelvic tumor who also did not receive radiotherapy (n = 178). In this population, albumin less than 2.8 g/dL was found to be independently associated with postoperative complications (odds ratio [OR], 4.69. 95% confidence intervals [CI], 1.03‐21.97; P = 0.046). Conclusions This study demonstrates that hypoalbuminemia (albumin < 2.8 g/dL) is associated with postoperative complications in patients with nonpelvic bone sarcomas who do not receive radiation. Future studies are necessary to further elucidate the role of nutrition, and they may show that nutritional status is a modifiable risk factor that can be optimized to improve the outcome of surgery for primary bone sarcomas.

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Predictors of soft‐tissue complications and deep infection in allograft reconstruction of the proximal tibia

Cited by 31 publications

References 19 publications

Topography: A Biophysical Approach to Direct the Fate of Mesenchymal Stem Cells in Tissue Engineering Applications

Topography: A Biophysical Approach to Direct the Fate of Mesenchymal Stem Cells in Tissue Engineering Applications

Thirty-Day Outcomes following Pediatric Bone and Soft Tissue Sarcoma Surgery: A NSQIP Pediatrics Analysis

Is malnutrition associated with postoperative complications in patients with primary bone sarcomas?

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