(P 88) THE RAY CHALLENGE: HOW MANY RAY RESECTIONS CAN PATIENTS TOLERATE AND WHICH RAY RESECTIONS AFFECTS FUNCTIONAL OUTCOME THE MOST IN ORTHOPEDIC ONCOLOGY?

Objective: Achieving complete resection with negative margins remains the primary objective in orthopedic oncology, with limb salvage becoming an increasingly important secondary goal. Treating foot sarcomas presents challenges due to anatomical constraints and limited reconstructive options, often leading to below-knee amputations (BKAs) which reliably achieve negative margins and acceptable function. However, limb salvage through ray resections can offer comparable survival and improved psychological outcomes when appropriately indicated.

Methods: This study retrospectively analyzed data from 39 patients who underwent single or multiple ray amputations for oncologic indications over the past 30 years. Patients were grouped into First Ray Amputation (1RA), Central Ray Amputation (CRA), Fifth Ray Amputation (5RA), and Multiple Ray Amputations (MRA). Functional outcomes, including pre- and post-operative TESS, MSTS87, and MSTS93 scores, were available for 25 patients and compared within subgroups and against a cohort of 25 BKA patients.

Results: Most patients (92.3%) achieved negative margins. Local recurrence occurred in 10.3% of cases, and wound dehiscence requiring debridement in 10.3% of patients. Functional scores improved postoperatively, with mean MSTS93 scores rising from 77.9 to 88.4 at five years. Mean MSTS93 scores for ray amputations and BKAs were 84.3 and 86.1, respectively, with no significant difference (p = 0.63). Fifth ray resections showed better tolerance and outcomes, while multiple ray resections were associated with greater functional decline.

Conclusion: Ray resections provide a viable limb salvage option with functional results comparable to BKA, particularly when negative margins are achieved. Further research is needed to clarify long-term outcomes based on ray involvement.