Soft tissue sarcomas are a rare heterogenous group of mesenchymal tumors with multiple histologic types that can arise in any of the soft tissues of the body. Current therapy for these tumors is multimodality incorporating limb saving wide surgical excision in combination with early adjuvant therapy. Radiation therapy is often used in order to reduce the risk of local recurrence after surgery. Our study focused on patients who had resection of a soft tissue sarcoma followed by brachytherapy. The objective of our study was to evaluate the effect of brachytherapy on soft reconstruction of surgical defects after wide local excision.

Methods

After approval by the Institutional Review Board at our institution, we retrospectively identified all patients who underwent surgical resection of a soft tissue sarcoma followed by brachytherapy. We identified 113 patients who were treated at our institution. Demographic data, surgical procedural details, radiation/brachytherapy data, wound healing complications, and follow-up data were compiled for all patients.

Results

The mean age at which patients underwent resection was 52.0 years (range 11-90, years). Forty-three patients underwent preoperative radiation treatment and an additional 30% received postoperative radiation therapy in addition to brachytherapy. The mean brachytherapy dose was 1680 cGy (range 1200-4500 cGy). A total of 43 patients had either a primary flap at the time of brachytherapy or a secondary flap because of wound complications or tumor recurrence. Eighty-six percent of flaps (37/43) were pedicle flaps while the rest were free tissue transfers. Three patients (2.7%) underwent extremity amputation secondary to recurrent disease. The most common complication was wound infection with a 15% incidence. Wound dehiscence and muscle necrosis occurred in 14.2% and 3.5% of patients, respectively. The incidence of skin graft loss was 8%. The overall mortality rate for our patient population was 21.2%. Eight percent of patients were alive with evidence of residual disease at last follow-up. More than two-thirds of our patients are currently alive without evidence of disease.

Conclusion

As advances in surgical care as well as radiation therapy broaden the limits of limb sparing surgery, soft tissue reconstruction and wound healing have become critical components of the successful management of the oncology patients. Radiation therapy, both external beam and brachytherapy have significant detrimental effects on normal wound healing. Based on our data, we feel that early plastic surgical soft tissue reconstruction offers advantages for the reduction of wound healing complications in the management of these complex patients.