2001 CTOS Annual Meeting Posters— Surgery

PREDICTIVE FACTORS FOR WOUND COMPLICATIONS FOLLOWING FREE AND PEDICLED SOFT TISSUE FLAPS FOR LIMB RECONSTRUCTION AFTER EXCISION OF SOFT TISSUE TUMOURS
A T Abudu¹,  R S Bell¹,  A M Griffin¹,  B O O'Sullivan²,  C N Catton²,  A M Davis¹,  J S Wunder^1
1University Musculoskeletal Oncology Unit, Mount Sinai Hospital, University of Toronto,,  ²Department of Radiation Oncology, Princess Margaret Hospital,

METHODS: Prospectively collected database records and the clinical data of all the patients who underwent excision of soft tissue sarcoma of the extremity and reconstruction with a free or pedicled soft tissue flaps at our centre were retrospectively reviewed. Wound complication was defined as a complication at the site of tumour excision necessitating a return trip to the operating room or prolonged wound packing. Chi-square test was used for analysis of nominal data.

RESULTS: 113 consecutive patients with soft tissue sarcoma who had limb preserving surgery with soft tissue reconstructive flaps were studied. The minimum follow-up was 24 months. The mean age was 55 years (16-95). The sarcoma was located in the lower extremity in 83 and upper extremity 30 patients. Adjuvant radiotherapy was administered pre-operatively in 64 patients, post-operatively in 31, brachytherapy in 4 and no radiotherapy in 14 patients. Significant wound complications developed in 37 patients (33%). The most common complications were wound infections or partial necrosis occurring in 16% (18/113) and 13% (15/113) respectively. Complete flap necrosis requiring flap removal occurred in 6 patients (5%). Three patients (2.3%) required amputation as a result of the complications. The statistically significant risk factors for development of wound complications include location of tumour in the lower limb compared to upper limb (relative risk 2.3, p=0.02) and use of pre-operative radiotherapy compared to no or post-operative radiotherapy (relative risk 2.05, p=0.02). There was no difference in rates of complications in patients with free or pedicled flaps, tumors < or > 5cm, distal or proximal location of tumour. The rates of negative excision margins (80%) and wound complications in patients who required reconstructive flaps were not different from that for the other patients treated at our center who did not require reconstructive flaps.

CONCLUSION: The use of soft tissue reconstructive flaps did not reduce the risk of positive excision margins or the rates of wound complications. Pre-operative radiotherapy and tumors located in the lower limb are the main risk factors for wound complications after the use of reconstructive flaps. The risk of amputation secondary to flap complication or failure is low.