Incidence, predictive factors, and proposed classification of wound complications in pediatric extremity bone sarcoma patients following extirpative surgery.

PURPOSE: There is a limited understanding of postoperative wound complications in osteosarcoma (OS) and Ewing sarcoma (ES) patients. Delays in adjuvant chemotherapy protocols due to such complications may significantly compromise overall survival rates. We aim to 1) report the incidence and contributing factors of wound complications following extremity extirpative surgery in OS and ES and 2) propose a clinically relevant wound classification scheme.

METHODS

A retrospective cohort study (Level of Evidence III) was conducted on extirpative surgeries for extremity bone sarcomas at a tertiary pediatric center over the past 16 years, ensuring a minimum follow-up period of 3 months. Patients were categorized based on whether they experienced postoperative wound complications. Fisher's exact test was employed to examine the demographic and clinical variables. Additionally, we present a new classification system aimed at accounting for any delays in the treatment protocol.

RESULTS

Among 88 patients, 69.3% had OS (n = 61) and 30.7% had ES (n = 27). Median age was 12.5 (IQR:9-15), with 55.7% (n = 49) male. 87.5% (77/88) of surgeries were limb salvages and 12.5% (11/88) were amputations. Overall wound complication rate was 43.2% (n = 38). Reported classifications were grade I (14/38, 36.8%), grade II (4/38, 10.5%), and grade III (20/38, 52.6%). Median time to complication was 30.5 days (IQR: 7.0-50.0). Tibia and fibula sarcomas (71.0%, 22/31) were associated with wound complications; femoral sarcomas (70.0%, 28/40) were associated with an absence of wound complications (p < 0.001). Wound complications were higher in patients with both orthopedic and plastic surgery reconstruction compared to those without (65.0% vs 35.0%, p < 0.01).

CONCLUSION

Postoperative wound complications occur in nearly half of pediatric patients with extremity bone sarcomas. Those with sarcomas in the tibia/fibula or who undergo combined orthopedic and plastic surgical reconstruction are particularly high risk. Our wound classification system reveals that grade III complications are most common, often leading to treatment delays. Accurate classification is essential for grasping the implications and enhancing patient outcomes. Larger studies are necessary to validate our system and findings.