Wound Complications in Preoperatively Irradiated Soft-Tissue Sarcomas of the Extremities

Abstract

Purpose To determine whether the involvement of plastic surgery and the use of vascularized tissue flaps reduces the frequency of major wound complications after radiation therapy for soft-tissue sarcomas (STS) of the extremities. Methods and Materials This retrospective study evaluated patients with STS of the extremities who underwent radiation therapy before surgery. Major complications were defined as secondary operations with anesthesia, seroma/hematoma aspirations, readmission for wound complications, or persistent deep packing. Results Between 1996 and 2010, 73 patients with extremity STS were preoperatively irradiated. Major wound complications occurred in 32% and secondary operations in 16% of patients. Plastic surgery closed 63% of the wounds, and vascularized tissue flaps were used in 22% of closures. When plastic surgery performed closure the frequency of secondary operations trended lower (11% vs 26%; P =.093), but the frequency of major wound complications was not different (28% vs 38%; P =.43). The use of a vascularized tissue flap seemed to have no effect on the frequency of complications. The occurrence of a major wound complication did not affect disease recurrence or survival. For all patients, 3-year local control was 94%, and overall survival was 72%. Conclusions The rates of wound complications and secondary operations in this study were very similar to previously published results. We were not able to demonstrate a significant relationship between the involvement of plastic surgery and the rate of wound complications, although there was a trend toward reduced secondary operations when plastic surgery was involved in the initial operation. Wound complications were manageable and did not compromise outcomes.

The introduction of early patient rehabilitation in surgery of soft tissue sarcoma and its impact on post-operative outcome

“…22 Major post-operative morbidity reached 32% and 35% in other series with pre-operative radiotherapy. 23,24 Compared to our findings in the post-operative setting, the concept of pre-operative radiotherapy in STS patients is challenged by its high morbidity rates.…”

Does postoperative infection after soft tissue sarcoma resection affect oncologic outcomes?

“…Standard of care for STS typically involves external beam radiation, as it has been shown to be beneficial with respect to oncologic outcomes [23,[29][30][31][32][33][34][35][36]. Unfortunately, one of the major drawbacks of radiation therapy is the increase in wound complications at Journal of Surgical Oncology the site of treatment [37][38][39], with infection often arising in the wound bed. Though this complication is significantly more problematic in patients receiving neoadjuvant external beam radiation as compared to adjuvant radiation, the literature has shown no demonstrable difference in oncologic outcomes between neoadjuvant and adjuvant radiation therapy [29,32,[39][40][41].…”

Soft Tissue Masses for the General Orthopedic Surgeon

“…40 Some centers advocate for plastic surgery involvement for closure, particularly in the setting of irradiated tissue, with one study noting a trend toward decreased reoperation rates. 41 …”