The role of reconstructive surgery in the treatment of soft tissue sarcomas

Plastic surgery plays an essential part in the treatment of many patients with soft tissue sarcomas. The results of this research shows that wound closure with free or pedicled flaps does not increase post-operative complication rates following sarcoma resection. Soft tissue sarcomas are rare, malignant tumours that often show a local aggressive growth or distant metastasis. Amputation of an arm or leg was a standard of care in the past. However, due to reconstructive surgery many patients can be treated limb-sparing nowadays. Reconstructive surgery achieves wound closure and coverage or reconstruction of vital structures such as bone, nerve, muscle or vessels. Despite the technical complexity of this procedure, this has no consequences on the postoperative complications rates. The results of this study show that radiotherapy and tumour localisation in the lower limbs, both known risk factors for postoperative complications, are not associated with complications when an operation wound is closed with a free of pedicled flap. As flap reconstructions provides a tension-free wound closure with well vascularized tissue, it may mitigate the adverse effects of those risk factors. The presence of comorbidities, a metastasis or high BMI are the most important risk factors in patients following a surgical flap reconstruction after sarcoma resection. Moreover, in the presence of multiple different risk factors the synergistic interaction must be taken into account, as interaction between variables can further increase the risk for the development of complications. No differences in postoperative complications and functional results were found between free and pedicled flap reconstructions. These results will enhance our knowledge of complication rates and contributing factors in patients undergoing soft tissue sarcoma resection and will contribute to improved pre-operative risk assessment and personalized care in the future