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Engineered Vascularized Muscle Flap
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A Size-Based Criteria for Flap Reconstruction After Thigh-Adductor, Soft-Tissue Sarcoma Resection.

Rostislav Novak1, Jennifer L Nevin2, Philip D Rowell2

  • 1University Musculoskeletal Oncology Unit, Mount Sinai Hospital, University of Toronto, Toronto, Canada. N_ROSTI@rambam.health.gov.il.

Annals of Surgical Oncology
|February 25, 2023
PubMed
Summary

Flap reconstruction for large adductor sarcomas improves wound healing without compromising oncologic or functional outcomes. This study provides size-based criteria to guide reconstructive choices for soft-tissue sarcoma patients.

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Area of Science:

  • Surgical Oncology
  • Reconstructive Surgery
  • Soft Tissue Sarcoma Management

Background:

  • Adductor compartment soft-tissue sarcoma resection carries high complication risks.
  • The impact of free/pedicled flaps on wound healing post-resection is not well-defined.

Purpose of the Study:

  • To compare wound complications, oncologic, and functional outcomes between flap reconstruction and primary closure for adductor sarcomas.
  • To establish criteria for selecting appropriate reconstruction methods based on tumor size.

Main Methods:

  • Retrospective cohort study of 177 patients undergoing adductor sarcoma resection.
  • Comparison of primary closure (PrC) versus free/pedicled flap reconstruction (FR).
  • Assessment of wound complications, oncologic, and functional outcomes (TESS/MSTS87/MSTS93), including Number Needed to Treat (NNT).

Main Results:

  • No significant difference in overall wound complication rates between PrC and FR.
  • Flap reconstruction (FR) was associated with a longer hospital stay (18 vs. 8 days).
  • FR demonstrated improved uncomplicated wound healing for larger tumors (≥15 cm or ≥800 ml), with NNT=8.4 for both; tumors >600 ml were 1.5x more likely to heal uneventfully with flaps.

Conclusions:

  • Flap reconstruction reduces wound complications in larger adductor sarcomas, despite increased hospitalization.
  • Both flap reconstruction and primary closure yield similar oncologic and functional outcomes.
  • Tumor size is a key factor in selecting flap reconstruction for improved wound healing.