Wound Complications Following Resection of Adductor Compartment Tumours

Abstract

Purpose Limb salvage surgery of soft tissue sarcomas is associated with both a risk of local recurrence and wound complications. Although the lower limb appears to be at greater risk of wound-related morbidity, few studies separate anatomical compartments. We believe that the adductor compartment of the thigh has a particularly high rate of complications and so performed a retrospective analysis of all soft tissue sarcomas arising in this region undergoing limb salvage.Patients Patients with intermediate and high grade adductor compartment tumours were identified from our database and the case notes were reviewed for patient, tumour, surgical and wound variables, identifying those with wound complications both before and after discharge.Results Of 49 patients who underwent limb salvage surgery, 22 (42.9%) developed complications. Twelve patients (24.5%) required further surgery prior to wound healing and 10 patients had delays in post-operative radiotherapy. There were significant differences in the rates of preceding surgery, open biopsy performed at other centres and previous radiotherapy to this region between the complicated and uncomplicated groups.Discussion The management of these difficult tumours carries a high rate of wound complications and requires careful planning prior to tissue biopsy. Open biopsies should be performed by the tumour surgeon to allow easy inclusion of this site in the definitive procedure. In previously irradiated or operated limbs, alternative strategies for wound management may need to be considered.

Surgical Outcome of Soft Tissue Sarcomas of the Adductor Compartment

“…Neo-adjuvant radiotherapy may increase the risk of wound complications, 8 but in our study most patients underwent neo-adjuvant radiotherapy to contain the lesions and had a lower complication rate. Surgery was performed at least 3 weeks after radiotherapy to let local inflammation recede, and might be delayed up to 6 weeks if inflammation persisted.…”

“…Major nerves, blood and lymphatic vessels traverse the adductor compartment, and if involved, may result in severe wound complications. 8 In a study of 184 patients undergoing tumour resection of the adductor compartment in 3 centres, the mean local recurrence rate of 3 centres was 17% (range, 5-28%) and the mean overall survival at these 3 centres was 65% (range, 58-74%) at 5 years. 7 In our study, the overall survival was 72% and the local control rate was 96% at 5 years.…”

“…Wound complications after resections are frequent and can afflict up to 36% of the patients. 1,7,8 We reviewed outcomes and complications of 25 consecutive patients with soft tissue sarcomas in the adductor compartment. 3 .…”

The Influence of Time Interval Between Preoperative Radiation and Surgical Resection on the Development of Wound Healing Complications in Extremity Soft Tissue Sarcoma

“…1,[14][15][16][17][18] Large dead spaces, devascularization of remaining tissue, and long, thin, undermined surgical flaps used to close the wound can all contribute to delayed wound healing. It has been reported that surgical wounds created in the absence of adjuvant therapy can take 2 or more years to complete the reparative process and may only reach 80 % of maximum tensile strength compared with uninjured tissue.…”

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

“…Only one study reported higher morbidity rates of 60%, which may be addressed by the fact that all patients additionally received isolated limb perfusion (ILP) . Two more groups applied radiation therapy in the third postoperative month after an average of 8.4 weeks and 10 weeks, respectively . This resulted in wound complication rates of 7% and 39%, respectively .…”