Managing Wound Complications After Osteosarcoma Resection: Stopping Adjuvant Therapy and Performing Secondary Closure

Purpose Adjuvant chemotherapy (AC) following limb-sparing surgery with endoprosthesis is the gold standard treatment for osteosarcoma (OS). However, AC can impair wound healing, leading to endoprosthesis exposure, making the decision to continue or pause AC important. We propose standard guidelines for managing this situation. Methods  This observational retrospective study analyzed local findings, AC courses, wound complications, and overall survival of 22 patients who underwent resection of primary OS. Results Of nine patients with wound complications (41%), two achieved secondary healing before starting AC while the other seven patients had wound deterioration during AC. Six patients had temporary suspension of AC, followed by debridement and secondary closure, and the completion of AC, one had temporary suspension of AC with conservative therapy, but could not complete AC due to too long suspension of AC. No recurrence or metastasis was recorded. Comparing these nine patients with the other 13 patients without wound complications, the number of days from the operation to the end of AC was 150 days and 144 days respectively, and no statistical differences were observed (p=0.648). Conclusion Managing wound complications after OS resection requires balancing the completion of AC with effective limb salvage strategies. Deciding on temporary suspension of AC without delay and secondary closure is important.