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Staged reconstruction of soft tissue sarcoma resections using temporizing negative pressure wound therapy is safe and efficacious

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European Journal of Plastic Surgery Aims and scope Submit manuscript

Abstract

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.

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Author information

Authors and Affiliations

  1. Department of Orthopaedic Surgery, Medical College of Wisconsin, Milwaukee, WI, USA

    John A. deVries, David M. King, Donald Hackbarth & John C. Neilson

  2. Department of Family Medicine, Columbia-St. Mary’s Hospital, Milwaukee, WI, USA

    Ashraf Abbas

  3. Department of Plastic Surgery, Medical College of Wisconsin, 9200 W. Wisconsin Ave., Milwaukee, WI, 53226, USA

    John LoGiudice

  4. Department of Radiation Oncology, Medical College of Wisconsin, Milwaukee, WI, USA

    Manpreet Bedi

Authors
  1. John A. deVries
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  2. Ashraf Abbas
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  3. David M. King
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  4. Donald Hackbarth
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  5. John LoGiudice
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  6. Manpreet Bedi
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  7. John C. Neilson
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Corresponding author

Correspondence to John LoGiudice.

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Conflict of interest

Two authors (JCN and DH) are board members of MTF Biologics (Musculoskeletal Transplant Foundation) and receive departmental general non-specific research support from MTF. One of these authors (DH) receives a stipend for participating in Board of Directors activities. John A. deVries, Ashraf Abbas, David M. King, John LoGiudice, and Manpreet Bedi declare no conflict of interest.

Ethical approval

This is a retrospective study conducted using existing patient data. Ethical approval was waived by our Institutional Review Board in view of the retrospective nature of the study, and all the procedures performed were part of the routine care.

Consent to participate

Patients are informed that our hospital is part of an academic (teaching) institution and that treatment records may be used in the preparation of papers to be presented at scientific meetings or submitted to academic journals. This understanding is part of their consent for treatment.

Consent to publish

None of the patients indicated unwillingness for such data to be published.

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An earlier version of this work was presented as an abstract at MSTS 2016 Annual Meeting the study did not receive special funding and was performed at Department of Orthopaedic Surgery, Medical College of Wisconsin and Froedtert Memorial Lutheran Hospital, Milwaukee, WI, USA

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deVries, J.A., Abbas, A., King, D.M. et al. Staged reconstruction of soft tissue sarcoma resections using temporizing negative pressure wound therapy is safe and efficacious. Eur J Plast Surg 45, 799–807 (2022). https://doi.org/10.1007/s00238-022-01938-1

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  • DOI: https://doi.org/10.1007/s00238-022-01938-1

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