Complications following reconstruction of soft-tissue sarcoma: importance of early participation of the plastic surgeon

BACKGROUND
Soft-tissue sarcomas (STSs) are rare malignant mesenchyme-derived tumors arising most frequently in the extremities. Current treatment involves wide excision and radiotherapy. Reconstruction of defects following limb-sparing surgery is best achieved with free flaps immediately after primary resection. Nevertheless, high rates of wound complications are expected, mainly due to postoperative radiotherapy. Patients inadequately treated with multiple surgeries and repetitive radiotherapy, are more prone to develop complications leading to worst functional outcomes.

METHODS
A retrospective analysis of patients referred for reconstruction following STS resection was performed. Patients were classified in the following 2 groups: group A, immediate reconstruction within 1 year since oncologic surgery and group B, delayed reconstruction after 1 year. Statistical analysis was carried out using Student t test and χ2. Odds ratio with 95% confidence interval was estimated.

RESULTS
A total of 30 patients were referred to our unit for reconstruction, with 14 patients corresponding to group A and 16 to group B. Significant difference was observed in complication rates between the groups (P < 0.05). Early reconstruction decreased the risk of complications (odds ratio, 0.06; 95% confidence interval, 0.01-0.36).

CONCLUSIONS
STSs are best treated in specialist centers. Early referral is highly recommended to achieve good oncologic outcomes. Our results show a clear tendency of higher wound complication rates in patients lately referred for reconstruction. We believe that early involvement of plastic surgeons in the management of STS is mandatory.

CITA DEL ARTÍCULO  Ann Plast Surg. 2012 Jul;69(1):73-8. doi: 10.1097/SAP.0b013e31821ee497