(P 355) CLASSIFYING WOUND HEALING COMPLICATIONS IN SURGICALLY TREATED EXTREMITY SOFT TISSUE SARCOMA

Objective: Wound healing complications occur in up to one-third of soft tissue sarcoma (STS) patients following limb-sparing resection and are a major source of morbidity. Despite their prevalence, no universally accepted classification system exists to characterize complication severity. We aimed to develop and apply a more comprehensive reporting system to enhance accuracy and clinical relevance.

Methods: We conducted a retrospective review of 186 adult patients with extremity or trunk STS treated surgically by orthopedic oncologists at a single institution (2013–2023). Data were imported to REDCap via extraction from the Electronic Medical Record. Exclusion criteria included intra-abdominal/retroperitoneal, intrathoracic, or head/neck tumors, or primary amputations. Wound healing complications were identified using previously reported terminology and a novel proposed scale (Types 1–4) reflecting level of intervention, OR return, and reconstructive demands. A senior investigator verified all complication classifications, and the primary complication was determined when multiple types were present.

Results: Of 186 patients, 62 (33.3%) had a wound complication: 52 (83.9%) lower extremity, 9 (14.5%) upper extremity, and 1 (1.6%) trunk. The most common complication was skin/tissue necrosis (41.9%), followed by seroma (24.2%), hematoma (12.9%), dehiscence (11.3%), and deep infection (6.5%). Time to complication ranged from 26–89 days, with necrosis presenting latest (mean 89 days). Reoperation was required in 75.8% of cases, including 88.5% of necrosis cases and 100% of deep infections. Multiple reoperations occurred in 37.1% of all complications, highest for deep infection (75%) and necrosis (52.1%). Preoperative radiation was received by 66.1% of those with complications. Refer to Table 1 for the proposed grading system and distribution of complication types.

Conclusion: Our proposed framework of reporting captures complication severity and resource utilization. These offer insight into the patient experience as well as demands on the healthcare system. Incorporating this system into STS literature going forward may improve comparability of future prospective investigations.

Proposed Classification System for Wound Healing Complications (n = 62)