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During the postoperative period, it is crucial to focus on maintaining circulation, identifying and managing potential complications, and planning for discharge.Nursing AssessmentVital signs monitoring: Regularly monitor vital signs, including blood pressure, heart rate, respiratory rate, and temperature, to detect early signs of complications such as bleeding and infection.Circulation assessment: Monitor pulses, perform Doppler assessments, and check capillary refill, color, temperature, and...
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Related Experiment Video

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Enhanced Recovery After Surgery in Lower-Extremity Sarcoma Reconstruction: A Scoping Review of Reported Components

Michael B Amrami1, Dylan K Kim, Lee D Yang

  • 1From the Division of Plastic Surgery, Department of Surgery, Columbia University Irving Medical Center, New York, NY.

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|March 24, 2026
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Summary

Enhanced Recovery After Surgery (ERAS) protocols can improve outcomes for lower-extremity sarcoma surgery. This review identifies ERAS components used in sarcoma reconstruction to guide future evidence-based pathways.

Keywords:
Enhanced Recovery After Surgerylimb salvagelower extremityperioperative carereconstructionresectionsarcomascoping review

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Area of Science:

  • Oncology
  • Surgical Innovation
  • Evidence-Based Medicine

Background:

  • Lower-extremity sarcoma surgery with flap reconstruction carries high postoperative morbidity risks.
  • Enhanced Recovery After Surgery (ERAS) protocols are established in other surgical fields but not yet for lower-extremity sarcoma.
  • This review aims to map existing ERAS components in sarcoma reconstruction literature.

Purpose of the Study:

  • To conduct a scoping review of ERAS components applied to lower-extremity sarcoma reconstruction.
  • To identify current practices and gaps in ERAS implementation for this patient population.
  • To inform the development of future sarcoma-specific ERAS protocols.

Main Methods:

  • Searched multiple databases (PubMed/MEDLINE, Embase, Web of Science, Cochrane) up to August 2024.
  • Included studies on lower-extremity sarcoma resection/reconstruction evaluating ERAS components.
  • Extracted data on study design, patient demographics, reconstruction details, ERAS elements, and outcomes.

Main Results:

  • 35 studies were included, analyzing various ERAS components.
  • Current smoking and elevated glucose levels correlated with increased infection and wound complications.
  • Prolonged drain use (>14 days) was linked to higher surgical-site infection (SSI) rates.
  • Short-term antibiotic prophylaxis (24h) showed similar SSI rates to longer regimens with fewer adverse events.

Conclusions:

  • Commonly reported ERAS components include nutrition, glucose control, analgesia, drain management, smoking cessation, and antibiotic duration.
  • Evidence signals and research gaps were identified for ERAS in lower-extremity sarcoma surgery.
  • Further research is required to establish specific, evidence-based ERAS pathways for this surgical subspecialty.