Staged reconstruction for resection wounds in sarcoma patients treated with brachytherapy

Adjuvant brachytherapy reduces local recurrences following wide local excision of large, high-grade sarcomas, but its use with immediate flap reconstruction is associated with a high wound complication rate following previous radiotherapy. To avoid flap irradiation and reduce wound-healing morbidity, a treatment strategy using negative-pressure wound therapy (NPWT) for temporary wound coverage during brachytherapy followed by delayed flap reconstruction was used in 3 previously irradiated sarcoma patients. NPWT was continued after brachytherapy catheter removal to stimulate vascularization, granulation, and wound contraction. Flap reconstructions were performed after the adequacy of the resection margins was pathologically confirmed and the wound bed appeared grossly vascularized. Prior to reconstruction, 2 patients required additional excision of positive or close permanent-section surgical margins. There were no major wound-healing complications during 9-18 months' follow-up. Staged closure using this approach may have advantages over immediate flap reconstruction in some sarcoma patients. Potential advantages include avoiding flap irradiation, reducing wound size and magnitude of the reconstructive procedure, and ensuring tumor-free surgical margins before definitive reconstruction.