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Limb-preserving Autologous Reconstruction In Patients With Soft-tissue Malignant Neoplasms: An Analysis Of 468 Cases From 2005 - 2017 ACS-NSQIP National Database
Samyd S. Bustos, M.D.1, Maria Yan, M.D.1, Doga Kuruoglu, M.D.1, Gabriel F. Martinez Galvez1, Antonio J. Forte, M.D., Ph.D., M.S.2, Brian T. Carlsen, M.D.1, Steven L. Moran, M.D.1, Oscar J. Manrique, M.D., F.A.C.S.1.
1Mayo Clinic, Rochester, MN, USA, 2Mayo Clinic, Jacksonville, FL, USA.

PURPOSE: Limb-sparing procedures are replacing amputations in patients with limb soft-tissue malignancies. Autologous reconstruction restores limb function while improving quality of life. However, nationwide studies comparing types of flap are lacking. Herein, we conduct a nationwide short-term outcomes analysis of limb-preserving autologous reconstruction in patients undergoing resection of soft-tissue malignant neoplasm.
METHODS: Patients who underwent limb-preserving autologous reconstruction after soft-tissue malignant neoplasm resection between 2005-2017 were identified using Current Procedural Terminology Codes for the excision/resection and their concurrent reconstruction in the ACS-NSQIP database. Demographics, operative characteristics, and surgical outcomes were assessed. Comparisons between type of flap and extremity were performed.
RESULTS: 468 cases were identified: 392 pedicled(121 upper and 271 lower extremities) and 76 free flaps(28 upper and 48 lower extremities). Overall mean age and BMI were 60.1 years and 29.4 kg/m2, respectively. Patient demographics were not statistically different between free and pedicled flap groups. The free flap group had a higher risk of unplanned reoperations(adjustedOR 3.6, 95%CI 1.6-8.3). The lower extremity group showed a higher risk of surgical-site infections(SSI) (adjustedOR 3.5, 95%CI 1.5-8.5). Overall, patients with an operative time above the median (3.4 hours) were associated with a higher risk of SSI, bleeding requiring transfusion, and unplanned reoperation (p<0.004).
CONCLUSION: Autologous reconstruction is a powerful option for limb preservation after soft-tissue malignant neoplasm resection. Based on ACS-NSQIP data, free flap reconstruction and lengthier operative time were associated with higher risk of complications. The therapeutic approach should be considered on an individual basis contemplating the risks and benefits of each type of flap.


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