Immediate Soft-Tissue Reconstruction in Pediatric Limb-Salvage Extremity Tumor Surgery: Patterns and Outcomes From...

Area of Science:

• Orthopedic Surgery
• Pediatric Oncology
• Reconstructive Surgery

Background:

• Limited data exists on the frequency and outcomes of immediate soft-tissue reconstruction in pediatric limb-salvage tumor surgery.
• Previous studies focused on higher-acuity cases, leaving a gap in understanding broader trends.

Purpose of the Study:

• To determine the frequency of immediate soft-tissue reconstruction in pediatric limb-salvage extremity tumor surgery.
• To analyze short-term outcomes, specifically wound complications and overall morbidity, associated with these reconstructions.

Main Methods:

• Utilized the ACS NSQIP-Pediatric database from 2012-2023.
• Included pediatric upper extremity (UE) and lower extremity (LE) oncologic excisions amenable to limb salvage.
• Identified immediate reconstruction using concurrent CPT codes; primary outcomes were complications and morbidity.

Main Results:

• Analyzed 4500 limb-salvage cases (4295 LE, 205 UE); 3.5% underwent immediate reconstruction (3.1% LE, 12.2% UE).
• Reconstructed cases had higher complication rates (27.7%) versus non-reconstructed (2.4%).
• In LE, reconstruction (OR=3.48) and ASA III-IV (OR=2.17) predicted 30-day complications.

Conclusions:

• Immediate soft-tissue reconstruction is infrequent in pediatric limb-salvage surgery.
• Reconstruction in LE was linked to higher short-term morbidity, but likely reflects greater case complexity.
• Findings offer benchmarks for case selection and future research in orthoplastic surgery.