What are the Results of Surgical Treatment of Postoperative Wound Complications in Soft Tissue Sarcoma? A Retrospective, Multi-Center Case Series.

BACKGROUND

Non-oncologic wound complications are common following resection of soft tissue sarcomas and factors predisposing to the development of complications have been extensively studied. To our knowledge, the methods and results of surgical treatment of these complications have not been reported. The purposes of this study were to 1) identify time to recognition, treatment employed, and eventual outcome of complications 2) investigate risk factors that may predispose patients to failure in management of complications following resection of soft tissue sarcomas.

METHODS

This was a multi-institutional, retrospective case series of patients treated with a primary closure of a limb sparing resection of a soft tissue sarcoma of the pelvis or extremity who developed a non-oncologic wound complication requiring operative intervention. The primary outcomes were a healed wound at the end of treatment and the total number of procedures required to address the complication.

RESULTS

There were 61 patients from 11 institutions included in the analysis. The median time from surgery to the initial recognition of a complication was 22 days (range 0-173 days), with 51 patients (84%) presenting in the first six weeks postoperatively. The definitive procedures included primary closure (44), healing by secondary intention (9), muscle flap (6), and skin graft (2). No patient was treated with an amputation. Six patients (10%) had a wound requiring continued dressing changes. 12 patients (20%) required at least one (range 1-4) additional unplanned procedure. In a bivariate analysis, we found patients with an infection were at increased risk of requiring multiple unplanned procedures (p=0.024).

CONCLUSION

Limb sparing resection of a soft tissue sarcoma is known to be at high risk of postoperative wound complications. We found that complications uncommonly present greater than six weeks after initial treatment and surgical management predictably results in retention of the affected limb and a healed wound in those requiring operative treatment.Level of Evidence: 4 - Case Series.