Optimizing Morbidity in Unplanned Soft Tissue Sarcoma Excisions Should We Skip the Reconstructive Ladder?

Rami Elmorsi, Luis Camacho, David D. Krijgh, Gordon S. Tilney, Heather Lyu, Raymond S. Traweek, Russell G. Witt, Margaret S. Roubaud, Christina L. Roland, Alexander F. Mericli*

*Corresponding author for this work

Research output: Contribution to journalArticleAcademicpeer-review

Abstract

Introduction: Soft tissue sarcomas (STSs) are rare and diverse primary malignant tumors that comprise approximately 1% of all malignancies. Misdiagnoses and unplanned excisions of STSs are common due to the tumor's rarity, leading to secondary tumor bed excisions (TBEs). Reconstructive outcomes for TBEs remain poorly understood, prompting this study to address the knowledge gap and inform preoperative discussions. Methods: This was a retrospective cohort study of patients who underwent STS excisions at a quaternary cancer center. Patients were categorized into mass excision (ME) and TBE groups. Reconstructive approaches were divided into simple (primary closure, complex repair, skin grafts, local flaps) and advanced (pedicled or free flaps). The groups were compared for postoperative outcomes, including complications, recurrence, and death. Results: When simple reconstructive techniques were used, TBEs exhibited higher rates of overall and major complications, whereas MEs had higher rates of overall and minor complications. Intergroup analysis revealed that with simple reconstruction, rates of overall and major complications were higher in TBEs than in MEs, and rates of minor complications were higher in MEs than in TBEs. Regression analyses revealed that simple reconstruction of TBEs had 90% and 180% higher odds of major complications and reoperation compared to simple reconstruction of MEs (P < 0.05). Conclusion: TBEs, despite their smaller size, exhibited a heightened susceptibility to overall and major complications, challenging the notion that simpler techniques suffice in these cases. Our findings encourage the consideration of advanced reconstructive techniques for TBEs that may seem amenable to simple reconstructive techniques.

Original languageEnglish
Pages (from-to)361-368
Number of pages8
JournalAnnals of Plastic Surgery
Volume93
Issue number3
DOIs
Publication statusPublished - 1 Sept 2024

Keywords

  • dimensions
  • free flaps
  • outcomes
  • plastic surgery
  • soft tissue sarcoma
  • surgical flaps
  • surgical oncology
  • wound healing

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