Function and health status outcomes following soft tissue reconstruction for limb preservation in extremity soft tissue sarcoma.
BACKGROUND
While advances in reconstructive surgery have facilitated limb preservation in extremity soft tissue sarcoma (ESTS), limited information exists as to the functional outcome of patients with these reconstructed extremities. The primary objective of this study is to evaluate the impact of flap reconstruction on postoperative function and health status in patients undergoing limb-salvage surgery for ESTS.


METHODS
Clinical and outcome data for eligible patients were extracted from a prospectively maintained database of sarcoma patients. Four outcome measures were used to assess three domains of function (impairments, activity limitations, and participation restrictions), and health status. The effect of soft tissue reconstruction on function and health status at 1-2-year follow-up was analyzed using univariate and multivariate regression.


RESULTS
Two hundred and forty-seven patients met eligibility criteria, including 56 patients receiving flap reconstruction and 191 patients treated with primary closure. Patients receiving flaps had larger (9.8 versus 7.1 cm; P = 0.003), higher-grade (93% versus 72%; P = 0.001) tumors, and more frequently received radiotherapy (89% versus 72%; P = 0.007), and bone (20% versus 4%; P = 0.001) and motor nerve resection (21% versus 10%; P = 0.032). Flap reconstruction was associated with more postoperative impairments [Musculoskeletal Tumor Society (MSTS) score 30.4 versus 32.2; P = 0.004] and activity limitations [Toronto Extremity Salvage Score (TESS) score 83.3 versus 89.5; P = 0.0132] on univariate analyses, but did not significantly predict postoperative function or health status outcomes on multivariate analyses.


CONCLUSIONS
Flap reconstruction was not an independent predictor of function and health status outcomes in patients with ESTS. However, ESTS patients receiving flaps had other clinical features placing them at risk for worse postoperative outcomes.
Davidge
Kristen M
KM
Division of Plastic and Reconstructive Surgery, University of Toronto, Toronto, Canada. kristen.davidge@utoronto.ca
Wunder
Jay
J
Tomlinson
George
G
Wong
Rebecca
R
Lipa
Joan
J
Davis
Aileen M
AM
D015331:Cohort Studies; D005260:Female; D005500:Follow-Up Studies; D006304:Health Status; D018219:Histiocytoma, Benign Fibrous / Q000473:pathology / Q000601:surgery*; D006801:Humans; D007890:Leiomyosarcoma / Q000473:pathology / Q000601:surgery*; D023821:Limb Salvage; D008080:Liposarcoma / Q000473:pathology / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications; D011446:Prospective Studies; D019651:Plastic Surgery Procedures; D012189:Retrospective Studies; D012983:Soft Tissue Neoplasms / Q000473:pathology / Q000601:surgery*; D013524:Surgical Flaps; D015996:Survival Rate; D016896:Treatment Outcome