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The Toronto Sarcoma Flap Score: A Validated Wound Complication Classification System for Extremity Soft Tissue
Anne C O'Neill1,2,3, Mélissa Roy4,5,6, Amelia Boucher4,5,6
1Division of Plastic and Reconstructive Surgery, Department of Surgical Oncology, University Health Network, Toronto, ON, Canada. Anne.O'Neill@uhn.ca.
Annals of Surgical Oncology
|October 2, 2020
Summary
A new scoring system, the Toronto Sarcoma Flap Score (TSFS), was developed to classify wound complications after extremity soft tissue sarcoma (ESTS) flap reconstruction. This objective tool demonstrates high reliability and can standardize reporting to improve patient care.
Area of Science:
- Orthopedic Surgery
- Surgical Oncology
- Plastic and Reconstructive Surgery
Background:
- Flap reconstruction is vital for limb preservation in extremity soft tissue sarcoma (ESTS) but often leads to wound complications.
- A standardized system for classifying these complications is currently lacking.
- This study aimed to develop and validate a novel classification system for wound complications post-ESTS flap reconstruction.
Purpose of the Study:
- To develop a standardized, objective, and reliable classification system for wound complications following extremity soft tissue sarcoma (ESTS) flap reconstruction.
- To validate the developed system for inter-rater and intra-rater reliability.
- To facilitate standardized outcome reporting and establish clinical benchmarks in sarcoma reconstruction.
Main Methods:
- A retrospective analysis of 300 patients undergoing ESTS flap reconstruction was conducted to identify and categorize wound and flap-related complications.
- A 10-point scoring system, the Toronto Sarcoma Flap Score (TSFS), was developed based on the required intervention level for each complication.
- The TSFS was validated prospectively in 100 patients, assessing inter-rater and intra-rater reliability.
Main Results:
- The developed 10-point Toronto Sarcoma Flap Score (TSFS) effectively categorized complications based on intervention necessity.
- Validation in a prospective cohort demonstrated excellent inter-rater (weighted Cohen's kappa range, 0.82–0.99) and intra-rater (0.95–0.97) reliability.
- Raters found the TSFS to be simple, objective, and reproducible, with high mean Likert scale scores for these attributes.
Conclusions:
- The Toronto Sarcoma Flap Score (TSFS) is a simple, objective, and highly reliable classification system for wound complications after ESTS flap reconstruction.
- The TSFS exhibits excellent inter- and intra-rater reliability, making it a robust tool for clinical assessment.
- Widespread adoption of the TSFS can standardize outcome reporting, improve data comparability, and enhance the quality of care in sarcoma reconstruction.
