Complications Following Reconstruction of Soft-Tissue Sarcoma

Marré, Diego; Buendia, Javier; Hontanilla, Bernardo

doi:10.1097/sap.0b013e31821ee497

Cited by 21 publications

(23 citation statements)

References 22 publications

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“…Historically, the treatment of extremity sarcomas was amputation of the affected limb 2 . However, in order to improve quality of life and functional outcomes, more recent management emphasizes that adequate control of the disease can be achieved through limb-sparing surgery 3 . For appropriately selected patients, chemotherapy and radiation have also demonstrated an overall survival advantage 4 .…”

Section: Introductionmentioning

confidence: 99%

A comparison of delayed versus immediate reconstruction following lower-extremity sarcoma resection

et al. 2020

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Background Identifying patients who may be at high risk for wound complications postsarcoma resection and reconstruction is essential for improving functional outcomes and quality of life. Currently, the effect of timing on sarcoma reconstruction has been poorly investigated. The purpose of this study was to compare outcomes of delayed and immediate reconstruction in the setting of sarcoma resection requiring flap reconstruction in the lower extremity. Methods A retrospective review of the senior author's sarcoma reconstruction patients from January 2005 to July 2017 was completed. All patients undergoing flap reconstruction of the lower extremity were included. Complications in the early postoperative period were compared between delayed and immediate reconstructive procedures. Results A total of 32 patients (7 delayed, 25 immediate) were included in this study. There was a significantly increased rate of overall complications (100% vs. 28.0%, P = 0.001) and rate of hematomas (28.6% vs. 0.0%, P = 0.042) in the delayed reconstruction group. Other complications including dehiscence, seroma, infection, venous thrombosis, and total/partial flap loss were also increased in the delayed reconstruction group, but this was not considered to be significant. Conclusions This study suggests that delayed reconstruction following sarcoma resection of the lower extremity had a higher incidence of overall complications and hematoma formation. We emphasize the importance of early plastic and reconstructive surgeon referral and the necessity to closely monitor delayed reconstruction patients for complications.

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Section: Introductionmentioning

confidence: 99%

A comparison of delayed versus immediate reconstruction following lower-extremity sarcoma resection

et al. 2020

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“…DFSP is best treated in specialist centers by experienced surgeons and pathologists. If DFSP develops on extremities or the acral region, early involvement of plastic surgeons is mandatory [ 9 ]. Multivariate analysis of 122 DFSP cases in a cancer hospital revealed that acral location, along with fibrosarcomatous change, are the main factors that are significantly associated with shorter recurrence-free survival.…”

Section: Discussionmentioning

confidence: 99%

Dermatofibrosarcoma protuberans, a rare but locally aggressive tumor on finger: clinical and aeromedical considerations

Chiang

Lee

Chu

2015

Case Reports in Plastic Surgery and Hand Surgery

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“…Functional muscle is not a prerequisite for limb salvage, and functional reconstruction is more technically demanding, time consuming, and expensive than soft tissue-only reconstruction [13,16,19,23]. Controversy also exists regarding the timing of functional reconstruction, with lack of clarity surrounding the definition of immediate reconstruction [20].…”

Section: Discussionmentioning

confidence: 99%

“…The paucity of data regarding complications, outcomes, and monetary cost of immediate functional reconstruction for upper extremity soft tissue defects following sarcoma resection may explain why this technique is not more widespread. Due to their low incidence, investigators have generally combined upper extremity functional reconstruction with lower extremity functional reconstruction in case series [11,20,22,28]. Conversely, articles addressing upper extremity reconstruction following soft tissue sarcoma resection have had few patients with functional reconstruction [1,34].…”

Section: Discussionmentioning

confidence: 99%

“…Patients included in the study had oncologic outcomes consistent with both delayed functional and soft tissue-only reconstructions [1,20,22,28]. Although patient perception of functionality following immediate reconstruction was high, patients undergoing reconstruction for sarcomas distal to the elbow had poorer functional outcomes and considered themselves slightly more disabled than patients undergoing reconstruction for sarcomas proximal to the elbow.…”

Section: Discussionmentioning

confidence: 99%

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Concomitant Upper Extremity Soft Tissue Sarcoma Limb-Sparing Resection and Functional Reconstruction: Assessment of Outcomes and Costs of Surgery

Mundinger

Prucz

Frassica

et al. 2013

Hand (New York, N,Y.)

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Background The purpose of this study is to investigate functional outcomes and cost impacts of immediate functional reconstruction performed in conjunction with limb-sparing resection of upper extremity soft tissue sarcomas. Methods Patients undergoing simultaneous limb-sparing upper extremity soft tissue sarcoma resection and functional reconstruction between December 1998 and March 2004 were retrospectively identified, their medical records reviewed, and costs of surgery analyzed. Functional outcomes and patient satisfaction were assessed via patient surveys and the Toronto Extremity Salvage Score (TESS). Results Thirteen patients met the inclusion criteria. Average follow-up was 43.3 months. Reconstructions included rotational innervated muscle flaps (n =6), free innervated myocutaneous flaps (n =1), and tendon transfers or grafts (n =6). Overall survival was 85 % (n =11) and disease-free survival was 77 % (n =10). Average total cost of surgery was $26,655. Patients undergoing reconstruction for hand and forearm sarcomas had significantly higher total costs of surgery than those undergoing reconstruction for elbow and upper arm sarcomas. Survey response rate was 91 % (n =10). Average TESS score was 76. Of the patients who worked preoperatively, 88 % returned to work postoperatively, and all patients who returned to work currently use their affected limb at work. Conclusions Patients undergoing immediate functional reconstruction for upper extremity soft tissue sarcoma resection achieved very good to excellent functional outcomes with quick recovery times and a high return-to-work rate following immediate functional reconstruction, thereby minimizing surgical cost impacts. Immediate functional reconstruction in the same surgical setting is thus a viable strategy following upper extremity soft tissue sarcoma resection.

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Complications Following Reconstruction of Soft-Tissue Sarcoma

Cited by 21 publications

References 22 publications

A comparison of delayed versus immediate reconstruction following lower-extremity sarcoma resection

A comparison of delayed versus immediate reconstruction following lower-extremity sarcoma resection

Dermatofibrosarcoma protuberans, a rare but locally aggressive tumor on finger: clinical and aeromedical considerations

Concomitant Upper Extremity Soft Tissue Sarcoma Limb-Sparing Resection and Functional Reconstruction: Assessment of Outcomes and Costs of Surgery

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