title: Outcomes after flap reconstruction for extremity soft tissue sarcoma: a case-control study using propensity score analysis.
abstract: BACKGROUND
  Because of the complexity of flap reconstruction and the magnitude of soft tissue defects, patients undergoing flap reconstruction for extremity soft tissue sarcoma (STS) may have increased morbidity and poor outcome compared with those undergoing primary closure. However, to examine the accurate impact of flap reconstruction on extremity STS patients, the potential bias by confounding factors should be minimized.
  
  
  METHODS
  We used propensity score analysis to match 37 patients who underwent flap reconstruction to 111 patients who underwent primary closure (1-3 ratio) based on patient and tumor characteristics at presentation. Treatment, functional, and oncologic outcomes were compared between the two groups.
  
  
  RESULTS
  Flap reconstruction group showed a lower Musculoskeletal Tumor Society functional score (P < 0.001), higher wound complication rate (P < 0.001), and longer hospital stay (P < 0.001); but had better local control (P = 0.015) than the primary closure group. Although failing to reach the statistical significance, the flap group tended to secure a wider surgical margin than the primary closure group (P = 0.051).
  
  
  CONCLUSIONS
  Patients who underwent flap reconstruction had increased morbidity associated with flap reconstruction, but better local control. These findings may have implications for treating extremity STS patients.
authors.affiliation: Department of Orthopaedic Surgery, Seoul National University Hospital, 101 Daehak-ro, Jongno-gu, Seoul 110-744, South Korea; Musculoskeletal Tumor Center, Seoul National University Cancer Hospital, 101 Daehak-ro, Jongno-gu, Seoul 110-744, South Korea. Electronic address: ziozio79@daum.net.
authors.forename: S
authors.initials: S
authors.lastname: Kang
authors.affiliation: Department of Orthopaedic Surgery, Seoul National University Hospital, 101 Daehak-ro, Jongno-gu, Seoul 110-744, South Korea; Musculoskeletal Tumor Center, Seoul National University Cancer Hospital, 101 Daehak-ro, Jongno-gu, Seoul 110-744, South Korea. Electronic address: hik19@snu.ac.kr.
authors.forename: I
authors.initials: I
authors.lastname: Han
authors.affiliation: Department of Statistics, Korea University, 145 Anam-ro, Seongbuk-gu, Seoul 136-701, South Korea. Electronic address: hayanery@naver.com.
authors.forename: S
authors.initials: S
authors.lastname: Kim
authors.affiliation: Department of Orthopaedic Surgery, Seoul National University Hospital, 101 Daehak-ro, Jongno-gu, Seoul 110-744, South Korea. Electronic address: orthoyhl@snu.ac.kr.
authors.forename: Y H
authors.initials: YH
authors.lastname: Lee
authors.affiliation: Department of Orthopaedic Surgery, Seoul National University Hospital, 101 Daehak-ro, Jongno-gu, Seoul 110-744, South Korea. Electronic address: minbom@naver.com.
authors.forename: M B
authors.initials: MB
authors.lastname: Kim
authors.affiliation: Department of Orthopaedic Surgery, Seoul National University Hospital, 101 Daehak-ro, Jongno-gu, Seoul 110-744, South Korea; Musculoskeletal Tumor Center, Seoul National University Cancer Hospital, 101 Daehak-ro, Jongno-gu, Seoul 110-744, South Korea. Electronic address: hankim@snu.ac.kr.
authors.forename: H-S
authors.initials: HS
authors.lastname: Kim
mesh_terms: D000328:Adult; D000368:Aged; D001132:Arm / Q000601:surgery*; D016022:Case-Control Studies; D015331:Cohort Studies; D005260:Female; D006801:Humans; D007866:Leg / Q000601:surgery*; D023821:Limb Salvage / Q000379:methods*; D008297:Male; D008875:Middle Aged; D057216:Propensity Score; D019651:Plastic Surgery Procedures; D012189:Retrospective Studies; D012509:Sarcoma / Q000601:surgery*; D018227:Sarcoma, Clear Cell; D013584:Sarcoma, Synovial / Q000601:surgery; D012983:Soft Tissue Neoplasms / Q000601:surgery*; D013524:Surgical Flaps; D016896:Treatment Outcome
keywords: Extremity; Flap; Function; MSTS; Musculoskeletal Tumor Society Rating Scale; Sarcoma