Pelvic tumors (Pelvic Tumor) refer to neoplastic lesions that originate primarily in, or secondarily involve, the pelvic ring skeleton (ilium, ischium, pubis, and sacrum), cartilage, and soft tissues of the pelvic wall, excluding tumors arising from intrapelvic organs such as the bladder, rectum, and ovaries. According to biological behavior, they can be classified as benign, borderline (intermediate), or malignant; according to origin, they can be divided into primary tumors arising from pelvic tissues and secondary tumors resulting from distant malignant tumors metastasizing to the pelvis [1]. Owing to the large tumor volume and the complex anatomy of adjacent pelvic viscera and major vessels, surgical resection of malignant pelvic tumors requires advanced techniques, is highly challenging, and is associated with numerous postoperative complications [2]. Postoperative wound infection is one of the common complications after pelvic tumor surgery. Wound infection prolongs the overall disease course, increases clinical workload, and imposes additional financial burdens on patients and their families; it also increases the likelihood of secondary debridement surgery and exacerbates psychological stress in patients and their families, leading to negative emotions. In this study, we retrospectively analyzed the experience in preventing, diagnosing, and treating postoperative wound infection after pelvic tumor surgery, and examined the associated risk factors for wound infection.

Main conclusions of this study: A history of diabetes mellitus, hypoalbuminemia before operation and postoperative fecal incontinence are independent risk factors for surgical site infection after pelvic tumor resection. The above risk factors should be considered when designing surgical resection protocols for pelvic tumors and implementing postoperative treatment and nursing management for surgical site infection.

Given the unique anatomical location and complexity of the pelvis, surgery for patients with pelvic tumors is often more challenging than that for other conditions. Moreover, resection of malignant pelvic tumors entails higher technical requirements and greater operative difficulty. Therefore, when formulating preoperative surgical plans for this specific patient population, clinicians should more comprehensively evaluate all patient information and physical conditions and determine whether relevant indicators are favorable for surgery. Clinicians should monitor for the development of fecal incontinence throughout postoperative treatment and nursing care.

Preoperative hyperglycemia and elevated glycated hemoglobin are independent risk factors for postoperative incisional infection, delayed wound healing, prosthesis-related infection, and prolonged hospitalization in orthopedic patients [4]. For patients with a history of diabetes mellitus, rigorous preoperative screening and optimization of glycemic control, along with individualized adjustment of glucose-lowering regimens, can significantly reduce perioperative infection risk, promote wound healing, and improve the medium- to long-term prognosis of prostheses [5]. Blood glucose levels should be closely monitored in strict accordance with medical orders before and after surgery. Patients and their caregivers are instructed to regularly monitor blood glucose, adopt a small and frequent meal pattern, and watch for nocturnal hypoglycemic manifestations. Timely health education shall be provided for patients with poor treatment compliance.

Routine preoperative nutritional risk screening is performed in all patients with pelvic tumors (NRS2002), malnutrition and low serum albumin levels in patients are independent risk factors for postoperative complications [6]. For those with low preoperative albumin and hemoglobin levels, timely intravenous hyperalimentation can be provided, and nutritional supplementation can be strengthened as prescribed (e.g., erythropoietin, polysaccharide iron, multivitamin tablets). Patients should be encouraged to eat small, frequent meals and consume high-protein, high-calorie, easily digestible foods to enhance appetite. Patients with pelvic tumors may also receive a carbohydrate-loading intervention 1 day before surgery; the routine recommendation is to consume 800 mL of a 12.5% carbohydrate beverage, which can effectively mitigate postoperative insulin resistance [7]. Prophylactic placement of air mattress and pressure-relieving mattress can be implemented preoperatively for patients undergoing pelvic surgery. Gel pads are additionally applied in malnourished patients to prevent pressure injuries. For patients confined to bed postoperatively, nursing staff shall strengthen ward rounds and assist family members with regular turning every day. Attention should be paid to all indwelling catheters during position shifting to avoid kinking or compression. For patients wearing anti-thromboembolic compression stockings and pelvic orthoses, patients and their caregivers are instructed to regularly remove the orthoses and adjust the stockings daily, with skin assessment over pressure-prone sites performed. Mepilex dressings are applied prophylactically over areas at high risk of pressure injury; dressings are checked routinely and abnormal findings are managed promptly.

After tumor resection and partial sacral nerve excision during pelvic tumor surgery, the surgical incision is anatomically close to the anus, leading to postoperative fecal incontinence in some patients and increasing the risk of wound contamination [8]. Therefore, postoperative patients should be closely monitored for the occurrence of fecal incontinence. The bed unit shall be kept clean and breathable daily, and the contaminated impermeable underpad shall be replaced promptly. Bedridden patients require regular positional changes to improve local ventilation around the perianal area and prevent skin lesions caused by prolonged compression and a moist environment. Stool-contaminated bedding of incontinent patients should be replaced immediately to prevent prolonged skin maceration by feces. For patients with frequent watery stool, ostomy bags can be applied around the anus to collect excreta. Diets prone to intestinal gas production are restricted, and relevant precautions for ostomy bag application are informed to patients. Close dynamic assessment and refined nursing of perianal skin are required postoperatively. Excreta should be promptly removed to keep the perianal skin clean and dry. Skin barrier films and pressure-relieving dressings are used to isolate fecal irritation for the prevention of incontinence-associated dermatitis and pressure injuries. Meanwhile, standardized dietary management is conducted to regulate intestinal rhythm; cold and irritant foods are restricted to reduce predisposing factors for diarrhea. Antidiarrheal agents and probiotic preparations are supplemented when necessary to regulate intestinal flora, and pelvic floor muscle training plus regular defecation training are carried out to improve anal continence function. In addition, combined nutritional support and individualized positional nursing can alleviate local tissue compression and fecal maceration, thereby effectively lowering the incidence of perianal skin breakdown, secondary infection and pressure injuries [9]. For patients with incontinence-associated dermatitis, health education and privacy protection measures should be implemented, nursing guidance should be intensified for patients and their caregivers, and relevant knowledge regarding skin care, dietary control and condition monitoring should be popularized [10].

The number of pelvic tumor surgeries performed at our center is currently limited, resulting in an insufficient sample size. In the future, we aim to include more clinical cases to provide stronger evidence for reducing the risk of infection associated with such procedures. For infected wounds, timely surgical debridement is also required to improve patients’ quality of life.

*First author.

^#Corresponding author.