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The Role of Reconstructive Surgery After Skeletal and Soft Tissue Sarcoma Resection

Suresh, Visakha, BSE*; Gao, Junheng, MS; Jung, Sin-Ho, PhD; Brigman, Brian, MD, PhD; Eward, William, MD, DVM; Erdmann, Detlev, MD, PhD, MHSc§

doi: 10.1097/SAP.0000000000001419
Clinical Papers
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Background Skeletal and soft tissue reconstruction after sarcoma resection remains challenging. The use of advanced reconstructive techniques has been shown to improve function and increase rates of limb salvage. This study aims to analyze the utilization of plastic surgery within a multidisciplinary team approach after sarcoma resection at Duke University Medical Center from 2001 to 2014.

Methods Medical records were reviewed to determine procedure type, postoperative complications, and tumor recurrence. Observations were stratified by oncologic diagnosis, anatomic location, and procedure type. Patients were excluded if final pathology was not indicative of sarcoma, if resection or reconstruction was not performed at our institution, if resection preceded reconstruction by greater than 60 days, or if no follow-up was recorded within 3 months.

Results Of the 747 patients who met the inclusion criteria, 116 underwent reconstructive surgery. Tumor location was associated with a need for surgical reconstruction. Patients with upper (P = 0.0073) or lower (P = 0.0265) extremity tumors had a higher occurrence of plastic surgery involvement. Patients with a history of operative interventions had a higher likelihood of reconstructive surgery after oncologic resection (odds ratio, 1.649; P = 0.019). Neoadjuvant radiotherapy was associated with an increased likelihood of reconstructive plastic surgery after sarcoma resection (odds ratio, 2.131; P = 0.0004).

Conclusions Understanding the factors that necessitate reconstructive plastic surgery after sarcoma resection can enhance coordination of care within a multidisciplinary sarcoma center and leading to improved patient outcomes, including rates of limb salvage, as well as functionality and esthetic results.

From the *Duke University School of Medicine; and

Departments of Biostatistics and Bioinformatics and

Orthopedic Surgery, and

§Division of Plastic, Maxillofacial, and Oral Surgery, Department of Surgery, Duke University Medical Center, Durham, NC.

Received December 15, 2017, and accepted for publication, after revision January 2, 2018.

Conflicts of interest and sources of funding: none declared.

Author Contributions: Visakha Suresh contributed to the study idea and design, data collection, data analysis and interpretation, and manuscript drafting and editing; Junheng Gao, data analysis, and manuscript drafting and editing; Sin-Ho Jung, data analysis, and manuscript drafting and editing; Brian Brigman, study design, and manuscript drafting and editing; William Eward, study design, and manuscript drafting and editing; Detlev Erdmann, study idea and design, data analysis and interpretation, and manuscript drafting and editing.

Presented at the 60th Annual Scientific Meeting of the Southeastern Society of Plastic and Reconstructive Surgeons; June 11–15, 2017; Sea Island, GA.

Reprints: Detlev Erdmann, MD, PhD, MHSc, DUMC, Box 3181, Durham, NC 27710. E-mail: detlev.erdmann@duke.edu.

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