Reconstructive approaches to oncologic upper and lower extremity resection in pediatric populations: A retrospective NSQIP-P analysis of 428 patients

Tumors of the soft tissue and bone in the upper and lower extremities are more common in pediatric populations than the general adult population and often require surgical resection or amputation. This retrospective study characterizes reconstructive approaches to such cases and subsequent postoperative outcomes.

All oncologic upper and lower extremity resection or amputation cases from 2013-2022 were identified in the NSQIP Pediatric database. Reconstructive approaches for each case were characterized. The main outcome of interest was the occurrence of ≥1 postoperative complication. Predictors of flap reconstruction and predictors of postoperative complications were assessed with stepwise logistic regression (p<0.05).

The final cohort comprised 428 cases. Most common reconstructive approaches included pedicled flaps (24.3%) and complex closure (8.9%). The rate of flap reconstruction increased from 4.4% in 2013-2016 to 34.6% in 2020-2022. Malignant tumors (odds ratio [OR]: 23.2, 95% confidence interval [CI]: 9.32-57.8) predicted higher likelihood of flap reconstruction than benign tumors, and proximal region (OR: 0.27, 95% CI: 0.15-0.51) predicted lower likelihood of flap reconstruction. Postoperative complications occurred in 19.9% of cases. Malignant tumors (OR: 4.39, 95% CI: 2.18-8.85) predicted higher likelihood of complications, and small soft tissue tumors (OR: 0.33, 95% CI: 0.14-0.77) predicted lower likelihood of complications than bone tumors.

Pediatric flap reconstruction of extremity tumors is largely reserved for cases with high oncologic burden and osseous tumors in the distal anatomical regions, including the tibia/fibula and forearm. Future work may assess flap reconstruction in other anatomical areas.