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A Size-Based Criteria for Flap Reconstruction After Thigh-Adductor, Soft-Tissue Sarcoma Resection.
Novak, Rostislav; Nevin, Jennifer L; Rowell, Philip D; Griffin, Anthony; Mazin, Sergey; Hofer, Stefan O P; O'Neill, Anne C; Tsoi, Kim; Ferguson, Peter C; Wunder, Jay S.
Afiliación
  • Novak R; University Musculoskeletal Oncology Unit, Mount Sinai Hospital, University of Toronto, Toronto, Canada. N_ROSTI@rambam.health.gov.il.
  • Nevin JL; University Musculoskeletal Oncology Unit, Mount Sinai Hospital, University of Toronto, Toronto, Canada.
  • Rowell PD; University Musculoskeletal Oncology Unit, Mount Sinai Hospital, University of Toronto, Toronto, Canada.
  • Griffin A; University Musculoskeletal Oncology Unit, Mount Sinai Hospital, University of Toronto, Toronto, Canada.
  • Mazin S; Department of Software Engineering, ORT Braude Academic College, Karmiel, Israel.
  • Hofer SOP; Division of Plastic and Reconstructive Surgery, University Health Network, University of Toronto, Toronto, Canada.
  • O'Neill AC; Department of Surgical Oncology, University Health Network, Toronto, Canada.
  • Tsoi K; Division of Plastic and Reconstructive Surgery, University Health Network, University of Toronto, Toronto, Canada.
  • Ferguson PC; Department of Surgical Oncology, University Health Network, Toronto, Canada.
  • Wunder JS; University Musculoskeletal Oncology Unit, Mount Sinai Hospital, University of Toronto, Toronto, Canada.
Ann Surg Oncol ; 30(6): 3701-3711, 2023 Jun.
Article en En | MEDLINE | ID: mdl-36840861
BACKGROUND: Resection of soft-tissue sarcomas from the adductor compartment is associated with significant complications. Free/pedicled flaps often are used for wound closure, but their effect on healing is unclear. We compared wound complications, oncologic, and functional outcomes for patients undergoing flap reconstruction or primary closure following resection of adductor sarcomas. METHODS: A total of 177 patients underwent resection of an adductor sarcoma with primary closure (PrC) or free/pedicled flap reconstruction (FR). Patient, tumor, and treatment characteristics were compared, as well as wound complications, oncologic, and functional outcomes (TESS/MSTS87/MSTS93). To examine the relative benefit of flap reconstruction, number needed to treat (NNT) was calculated. RESULTS: In total, 143 patients underwent PrC and 34 had FR, 68% of which were pedicled. There were few differences in demographic, tumor, or treatment characteristics. No significant difference was found in the rate of wound complications. Length of stay was significantly longer in FR (18 days vs. PrC 8 days; p < 0.01). Oncologic and functional outcomes were similar over 5 years follow-up. Uncomplicated wound healing occurred more often in FR compared with PrC for tumors with ≥15 cm (NNT = 8.4) or volumes ≥ 800 ml (NNT = 8.4). Tumors ≤ 336 ml do not benefit from a flap, whereas those > 600 ml are 1.5 times more likely to heal uneventfully after flap closure. CONCLUSIONS: Although flap use prolonged hospitalization, it decreased wound healing complications for larger tumors, and in all sized tumors, it demonstrated similar functional and oncologic outcomes to primary closure. Our size-based treatment criteria can help to identify patients with large adductor sarcomas who could benefit from flap reconstruction. LEVEL OF EVIDENCE III: (Retrospective cohort study).
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Texto completo: 1 Colección: 01-internacional Base de datos: MEDLINE Asunto principal: Sarcoma / Neoplasias de los Tejidos Blandos / Procedimientos de Cirugía Plástica / Colgajos Tisulares Libres Tipo de estudio: Observational_studies / Prognostic_studies / Risk_factors_studies Límite: Humans Idioma: En Revista: Ann Surg Oncol Asunto de la revista: NEOPLASIAS Año: 2023 Tipo del documento: Article País de afiliación: Canadá Pais de publicación: Estados Unidos
Texto completo
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XML
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Texto completo: 1 Colección: 01-internacional Base de datos: MEDLINE Asunto principal: Sarcoma / Neoplasias de los Tejidos Blandos / Procedimientos de Cirugía Plástica / Colgajos Tisulares Libres Tipo de estudio: Observational_studies / Prognostic_studies / Risk_factors_studies Límite: Humans Idioma: En Revista: Ann Surg Oncol Asunto de la revista: NEOPLASIAS Año: 2023 Tipo del documento: Article País de afiliación: Canadá Pais de publicación: Estados Unidos