Use of negative pressure wound therapy as an adjunct to the treatment of extremity soft-tissue sarcoma with ulceration or impending ulceration

Abstract

Abstract. Major wound complications of the extremities, following wide tumor resection and reconstruction for soft-tissue sarcomas (STSs), remain a challenge for limb-sparing surgery. Furthermore, STSs with ulceration or impending ulceration predispose patients to an increased risk of post-operative infection. The present study was conducted to assess the efficacy of negative pressure wound therapy (NPWT) in preventing wound complications associated with surgical treatment of STSs with ulceration or impending ulceration, in patients treated between February 2012 and January 2013. A total of 5 patients, with a mean age of 48 years (range, 24-68 years), were enrolled in the present study. The diagnoses consisted of undifferentiated pleomorphic sarcoma (n=2), leiomyosarcoma (n=1), synovial sarcoma (n=1) and epithelioid sarcoma (n=1). According to American Joint Committee on Cancer criteria, 3 cases were stage III tumors, and the remaining 2 cases were of stages ⅡA and ⅡB, respectively. A total of 3 patients exhibited ulceration at diagnosis, and the remaining patients demonstrated impending ulceration. The mean wound area following wide resection of the tumor was 73 cm 2 (range, 45-110 cm 2 ). A continuous suction mode, with pressures measuring -200 to -300 mmHg, was used for 7-10 days on the soft-tissue defects as preparation for wound closure. Soft-tissue reconstruction included muscle flaps (n=2) and skin grafts (n=5). No major wound complications occurred. Post-operative functional and cosmetic outcomes were acceptable. A single patient demonstrated local recurrence 12 months after surgery and re-excision of the tumor was performed. All patients remained alive at the conclusion of follow-up, with a mean follow-up time of 26 months (range, 12-36 months). The present study demonstrated that NPWT is effective and safe when used as an adjunct to wound closure following resection of extremity STS with ulceration/impending ulceration.

Is the Addition of Anaerobic Coverage to Perioperative Antibiotic Prophylaxis During Soft Tissue Sarcoma Resection Associated With a Reduction in the Proportion of Wound Complications?

“…Although these are not modifiable variables, many factors that have been associated with wound complications in the evidence are. These include patient factors such as smoking cessation and tight glycemic control, the use of vascularized tissue coverage using free or rotational flaps, alterations to radiation dosage and fractionation, or the use of negative pressure dressings, all of which may affect major wound complication rates as well [4‐6, 14, 15, 21, 23, 25, 28, 30]. Future prospective studies examining these in a controlled setting may be of benefit to patients.…”

A prospective, phase II study on the safety and efficacy of negative pressure closure for the stabilization of split‐thickness skin graft in large or muscle‐exposing defects: The NPSG study

“…11,[13][14][15] Although optimal negative pressures for graft stabilization have not been fully established, lower negative pressure has been attempted. 16,17 Isago et al have reported survival rate of 95% or higher of skin graft fixed with NPC at a negative pressure of 25 mmHg in 10 patients. 18 Argenta et al 19 reported a high survival rate for skin grafts at negative pressures of 50-70 mmHg.…”

Closed incision negative pressure wound therapy versus conventional dressings following soft-tissue sarcoma excision: a prospective, randomized controlled trial

“…Chen et al 33 reported that NPWT was safe and effective in a series of five patients who required skin grafts following STS excision. Tumour diameter, proximity to skin, and proximal lower limb tumours are important factors which have been associated with an increased risk of wound complications.…”