Immediate versus Delayed Sarcoma Reconstruction: Impact on Outcomes.

Kyle J Sanniec,Lyndsey A Bryant,Nan Zhang,William J Casey Iii,Alanna M Rebecca,Raman C Mahabir,Cristine S Velazco

doi:10.1155/2016/7972318

Abstract

Background. Sarcoma is a rare malignancy, and more recent management algorithms emphasize a multidisciplinary approach and limb salvage, which has resulted in an increase in overall survival and limb preservation. However, limb salvage has resulted in a higher rate of wound complications. Objective. To compare the complications between immediate and delayed (>three weeks) reconstruction in the multidisciplinary limb salvage sarcoma patient population. Methods. A ten-year retrospective review of patients who underwent sarcoma resection was performed. The outcome of interest was wound complication in the postoperative period based on timing of reconstruction. We defined infection as any infection requiring intravenous antibiotics, partial flap failure as any flap requiring a debridement or revision, hematoma/seroma as any hematoma/seroma requiring drainage, and wound dehiscence as a wound that was not completely intact by three weeks postoperatively. Results. 70 (17 delayed, 53 immediate) patients who underwent sarcoma resection and reconstruction met the inclusion criteria. Delayed reconstruction significantly increased the incidence of postoperative wound infection and wound dehiscence. There was no difference in partial or total flap loss, hematoma, or seroma between the two groups. Discussion and Conclusion. Immediate reconstruction results in decreased wound complications may reduce the morbidity associated with multidisciplinary treatment in the limb salvage sarcoma patient.

Highlights

Sarcoma remains a rare malignancy and accounts for less than 1% of all newly diagnosed cancers (∼11,000 new diagnoses a year in the United States) [1]
In exploring the etiology of these wound complications, our group uncovered a potential benefit in immediate reconstruction following sarcoma resection [6]
Delayed reconstruction was defined as any reconstruction occurring three weeks after primary oncologic resection, and immediate reconstruction was defined as any reconstruction within a three-week timeframe

Summary

Introduction

Sarcoma remains a rare malignancy and accounts for less than 1% of all newly diagnosed cancers (∼11,000 new diagnoses a year in the United States) [1]. While early descriptions of treatment were focused on limb amputation, more recent management algorithms emphasize a multidisciplinary approach and limb salvage when feasible The result of this evolution in care is increased overall survival and limb preservation [2], but the tradeoff being a higher rate of wound complications [3,4,5]. Sarcoma is a rare malignancy, and more recent management algorithms emphasize a multidisciplinary approach and limb salvage, which has resulted in an increase in overall survival and limb preservation. To compare the complications between immediate and delayed (>three weeks) reconstruction in the multidisciplinary limb salvage sarcoma patient population. Immediate reconstruction results in decreased wound complications may reduce the morbidity associated with multidisciplinary treatment in the limb salvage sarcoma patient

Methods

Results

Conclusion