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Erschienen in:
01.03.2022 | Original Paper
Staged reconstruction of soft tissue sarcoma resections using temporizing negative pressure wound therapy is safe and efficacious
Erschienen in: European Journal of Plastic Surgery | Ausgabe 5/2022
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Background
Ensuring a negative-margin resection of soft tissue sarcomas (STS) is crucial to minimizing the risk of local recurrence. Resection of STS followed by temporizing vacuum-assisted closure (VAC) therapy ensures negative margins are obtained prior to complex soft tissue reconstructions. We sought to determine early oncologic outcomes of this protocol by examining complications, positive margin status, local recurrence, and the development of metastatic disease.
Methods
Patients diagnosed with STS of the extremities who underwent a wide resection and VAC application followed by a separate reconstructive procedure once negative margins were confirmed were included. Clinical data was retrospectively collected and analyzed. The results of this study group were compared to an institutional cohort of STS patients during the same time frame treated with immediate reconstruction.
Results
Among 35 staged protocol patients with median follow-up of 73 months (minimum 25 months), local recurrence was 5.7%, distant metastasis was 28.6%, disease-free survival was 65.7%, and wound complications occurred in 14.3%. Compared to a similar institutional control cohort not undergoing temporizing VAC placement, there were no statistical differences in any outcome measures.
Conclusions
A staged reconstruction of soft tissue sarcoma resections offers a promising option for patients felt to be at a higher risk of positive margin resection. Our initial results indicate this may provide the benefit of ensuring a negative-margin resection prior to a complex soft tissue reconstruction with low wound complication rates and similar outcomes compared to an institutional cohort of immediately reconstructed patients.
Level of evidence: Level III, risk/prognostic.