Risk Factors for Wound Complications After Soft Tissue Sarcoma Resection

Perrault, David; Lee, Gene K.; Yu, Roy P.; Carre, Antoine L.; Chattha, Anmol; Johnson, M. P.; Gardner, Daniel J.; Carey, Joseph N.; Tseng, William W.; Menendez, Lawrence R.; Wong, Alex K.

doi:10.1097/sap.0000000000002592

Cited by 16 publications

(15 citation statements)

References 24 publications

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“…The incidence of haematoma was very low in both the CB and CBD groups. This matches a previous study which reported four haematomas in 118 STT patients [ 6 ]. Therefore, another study with greater numbers of postoperative haematomas may be needed to accurately evaluate the effect of surgical drains.…”

Section: Discussionsupporting

confidence: 93%

“…Such complications include SSI, seroma, haematoma, and wound dehiscence, all of which can directly and indirectly adversely affect morbidity and mortality. Various risk factors affecting wound complication incidence have been documented, including tumour location, neoadjuvant chemotherapy, and radiotherapy [ 6 ]. When poorly managed, these complications may necessitate limb amputation.…”

Section: Discussionmentioning

confidence: 99%

“…All other tested variables, including time to wound healing, SSI, and formation of seroma and haematoma, showed no statistical significance. Although wound dehiscence is a well-recognised complication of STT resection [ 6 ], it was not included in the final analysis, as a primary cause is SSI, which was another variable. Differentiating between dehiscence secondary to SSI versus other causes was unreliable, and, therefore, determining the additional effect of surgical drain insertion was difficult.…”

Section: Discussionmentioning

confidence: 99%

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Value of Drains in Soft-Tissue Tumour Surgery: A Specialist Regional Centre Experience

El-Omar¹,

Akbani²,

Abdelrahman³

et al. 2022

Cureus

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Background The mainstay of therapy in most soft-tissue tumours (STTs) is excision. However, this often results in blood/extracellular fluid collection within large dead spaces necessitating the use of surgical drains. Whether meticulous attention to haemostasis, careful closure of dead space, and use of compression bandage obviates the need for drains was investigated. This study aimed to compare postoperative outcomes in patients undergoing surgery for STTs with and without the use of drains. Methodology A retrospective analysis of patients undergoing STT surgery over five years was undertaken using a regional STT specialist service database. Patients were stratified into the following two groups: compression bandage alone (CB) versus compression bandage with drain (CBD). The chi-square test was used to examine associations with infection, seroma, and haematoma, while the unpaired t-test was used for associations with hospital stay and time to wound healing. The unpaired t-test with Bonferroni correction was used to account for tumour dimensions across both groups. Results A total of 81 CB and 25 CBD patients were included. The mean hospital stay was significantly lower in CB compared to CBD (4.9 days, SD = 8.574 vs. 9.8 days, SD = 7.647, p = 0.0125). None of the other variables was significantly different between the two groups, including infection (21.3% vs. 24.0%, p = 0.7804), seroma (25.0% vs. 36.0%, p = 0.2865), haematoma (0.026% vs. 2.0%, p = 0.2325), and time to wound healing (55.8 days, SD = 63.59 vs. 42.3 days, SD = 58.88, p = 0.3648). Conclusions Our findings suggest that the use of drains in patients undergoing STT tumour surgery lengthens hospital stay without reducing the incidence of postoperative complications/time to wound healing. A larger, prospective trial is needed.

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Section: Discussionsupporting

confidence: 93%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

Value of Drains in Soft-Tissue Tumour Surgery: A Specialist Regional Centre Experience

El-Omar¹,

Akbani²,

Abdelrahman³

et al. 2022

Cureus

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“…In one series, wound complications were recorded in 43.3%. It was more common in cases of vascular reconstruction (34.5% vs 15.3%; p = 0.05) 10 .…”

Section: Survival and Effect Of Different Prognostic Factorsmentioning

confidence: 94%

Surgical and Oncological Outcomes of Extremity soft Tissue Sarcoma following en bloc Resection of the Neurovascular Bundle

Haitham Fekry Othman,

Reham Saied Oreaba,

Marawan Yousry

et al. 2022

IJPHRD

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Purpose: Vascular involvement is a major limitation in attaining limb salvage with negative margins for managing soft tissue sarcomas (STS). The study evaluated surgical and oncological outcomes of vascular resection and reconstruction during the management of extremities STS. Methods:The study involved 60 patients with STS treated with limb-sparing surgery divided into two groups; the reconstruction Group (n=30) needed vascular reconstruction (Vr) due to vascular involvement, and the Nonreconstruction Group (n=30) did not require vascular resection. All patients were followed up for at least one year to compare surgical and oncological outcomes.Results: Vascular reconstruction involved a major artery and vein (n=16), a major artery alone (n=13), or a major vein alone (n=1). Most patients (n = 22) had Vr with a saphenous vein graft. An artificial Gore-Tex graft was used in the other cases. A primary vascular repair was possible for the femoral artery in 3 more patients. Major wound complications, DVT, and persistent severe edema were more frequent in the reconstruction Group (p = 0.004 0.015, and 0.001, respectively). Amputation was eventually required in 17% of the reconstruction group and a single patient in the non-reconstruction group. The overall survival (OS) at 18 months was apparently higher in the reconstruction group (85.9%) than the non-reconstruction group (64.7%, p = 0.063). On multivariate analysis, age at diagnosis and surgical margin were the independent factors affecting OS. The functional outcome of both groups was similar (p= 0.676). Conclusion:En-bloc resection of major vascular structures with the tumor and reconstruction has proven to be a feasible option in limb-salvage surgery. Vascular resection en bloc with limb sarcoma in locally advanced disease increases the safety of the surgical margins and gives comparable life expectancy and rFS to limb sarcoma patients with early disease who were treated with resection without vascular involvement. However, it keeps the advantage of having preserved functioning limb.

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“…39,46 The use of keystone flaps, propeller flaps, or local pedicle perforator flaps in the torso and extremity has been well-described and can be used just as reliably for sarcoma reconstruction. 46,47 However, in the setting when the resection is more extensive (>100 cm 2 in the upper extremity), especially to obtain clear margins, a free tissue transfer is often necessary, with numerous studies confirming high success rates despite prior radiation therapy. 34,[48][49][50][51] 1091e…”

Section: Reconstructive Algorithmmentioning

confidence: 99%

Practical Strategies in Reconstruction of Soft-Tissue Sarcoma

Aten

Chang

2022

Plastic &Amp; Reconstructive Surgery

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Learning Objectives: After studying this article, the participant should be able to: 1. Discuss the natural history and pathophysiology of sarcoma. 2. Summarize the most up-to-date multidisciplinary management of soft-tissue sarcoma. 3. Provide a synopsis of reconstructive modalities based on anatomical location. 4. Highlight some novel strategies for treatment of lymphedema and phantom limb pain that are common sequelae following treatment and resection of soft-tissue sarcomas. Summary: The management of soft-tissue sarcoma presents unique challenges to the reconstructive surgeon. The optimal management mandates a multidisciplinary approach; however, reconstruction must take into account the extent of the resection and exposed vital structures, but often occurs in the setting of adjuvant treatments including chemotherapy and radiation therapy. Reconstruction is based on the extent of the defect and the location of the primary tumor. As such, an evidence-based, algorithmic approach following the reconstructive ladder is warranted to minimize the risks of complications and maximize success, which varies from head and neck to torso to breast to extremity sarcomas. Aside from reconstruction of the defect, advances in the surgical treatment of lymphedema and neuropathic pain resulting from treatment and extirpation of soft-tissue sarcoma are critical to maintain function and patients’ quality of life.

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Risk Factors for Wound Complications After Soft Tissue Sarcoma Resection

Cited by 16 publications

References 24 publications

Value of Drains in Soft-Tissue Tumour Surgery: A Specialist Regional Centre Experience

Value of Drains in Soft-Tissue Tumour Surgery: A Specialist Regional Centre Experience

Surgical and Oncological Outcomes of Extremity soft Tissue Sarcoma following en bloc Resection of the Neurovascular Bundle

Practical Strategies in Reconstruction of Soft-Tissue Sarcoma

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