Outcomes Analysis of the Role of Plastic Surgery in Extremity Sarcoma Treatment

Abstract

Over the past 5 years we have developed a multidisciplinary service for the treatment of extremity sarcoma. This service includes orthopedic oncology, neurosurgery, medical and radiation oncology, and plastic surgery. Prior to 2007, the role of plastic surgery in this multidisciplinary team was limited. After 2007, plastic surgery at our institution played an increasingly integral role in multidisciplinary care. Based on the development of the plastic surgery service at our institution, we were able to evaluate the role of plastic surgery in the outcomes following extremity reconstruction after sarcoma resection. We hypothesize that plastic surgery involvement would reduce the amputation rate without altering recurrence rates. We found a decrease in lower-extremity amputation of approximately 20% without any significant change in recurrence rates. The incidence of infectious complications requiring IV antibiotics decreased by about 20%. The incidence of skin graft loss decreased by 75%. We do report a significant increase in partial flap necrosis. Overall, plastic surgery is an essential component of the multidisciplinary team in the care of extremity sarcoma.

Therapeutic options and postoperative wound complications after extremity soft tissue sarcoma resection and postoperative external beam radiotherapy

“…In theory, flap reconstruction after STS resection and radiation should decrease perioperative morbidity rates. Matching results were described in some studies showing increased morbidity rates in patients treated with direct closure rather than vascularised flap reconstruction . O'Sullivan et al found that complication rates after direct closure were 15%, compared to 2% with additional vascularised tissue transfer.…”

“…The mean total dose in the reviewed literature was relatively homogenous and ranged from 50 to 70 Gray (Gy), with details shown in Table . It was not mentioned in six studies . The fractionation of the radiotherapy dose was either 1.8 or 2 Gy as shown in Table .…”

“…Other factors disturbing wound healing are tension on wound edges, large dead spaces or compromised wound vicinity. The risk even increases with additional radiotherapy and leads to wound healing disorders, including dehiscence, infection, seroma and haematoma . Most of these problems can potentially be overcome by tension‐free reconstruction using vascularised tissue transfer.…”

“…Reviewing the literature, it is of utmost importance to distinguish between flap‐related vs wound morbidity. The latter can be classified either according to Common Terminology Criteria for Adverse Events or as major and minor where the major wound complications require operative intervention or hospital admission unlike their minor counterparts …”

“…This group reported morbidity rates of 13% following primary closure vs 3% after additional flap reconstruction . Agrawal et al described two patient cohorts; one was before a plastic surgery service was introduced in their institution and the other cohort came thereafter. The authors described a decreased incidence of wound infection and dehiscence, seroma or haematoma after plastic surgery was included in the treatment.…”