Impact of vacuum assisted wound therapy on wound complications in STS surgery- A 3-year retrospective single-centre analysis

Abstract

Purpose: In sarcomas, surgery is an essential component of therapy. Depending on their location, sarcomas can reach a considerable size, which increases the risk of wound complications (WC) after resections. This often results in longer hospital stays and thus delays further oncological treatment. Therefore, reducing WCs is indispensable for improving treatment. The VAC (Vacuum-Assisted Closure) therapy has been shown to have a positive effect on wound healing, but there are limited studies for its use after sarcoma resections. The aim of this study was to analyze the outcomes of various wound closure techniques. This was intended to identify optimal wound care to prevent WCs and to determine risk factors for complications.

Methods: This study is a single-center study that included all patients who underwent surgery for sarcomas of the body surface and extremities. A retrospective data analysis was conducted for the years 2021-2023. The primary endpoint was the development of wound complications. Here, primary wound closure was compared with secondary closure after negative wound pressure therapy (NWPT). Secondary endpoints included the impact of drains, subtype, location, and comorbidities.

Results: A total of 211 patients were examined. The most common histological subtype was liposarcoma (32,88%), followed by undifferentiated sarcoma (19,18%). Wound complications occurred in 30,19% of all cases. The analysis showed that 40,4% of patients with primary wound closure developed a complication, while only 20% of patients with NWPT did. A significant risk factor for the development of a WC was a tumor diameter > 10 cm, which led to a 20,13% higher risk of infection compared to smaller tumors. 68.3% of wound complications occurred in the lower extremity. Additionally, neoadjuvant therapy, longer operation time and immunosuppression were detected as risk factors for a higher complication rate.

Conclusions: This study highlights the significantly increased risk of WCs in large sarcomas of the lower extremities. VAC therapy showed a significant improvement in wound closure especially in high-risk cases. Based on the results, the use of NWPT can be essential for wound management in sarcomas and improve convalescence and oncological treatment.

Keywords: Postoperative complications; Sarcoma surgery; Secondary wound closure; Soft tissue sarcoma; Vacuum assisted wound closure; Wound complication.

Fig. 1

Risk factors for wound complications

Fig. 2

Tumor Size as a Risk factor for wound complications: Increased Risk of WCs in Tumors > 10 cm (30% of all patients), 10–20 cm (24% of all patients) and > 20 cm (16% of all patients)

Fig. 3

Wound complication rate after primary and secondary wound closure in all tumors (significant decrease of WCs from 39,6–24%); only malignant tumors (Decrease from 40,4–20%); tumors on the lower extremity (Decrease from 42% to 21,4%)

Fig. 4

Wound complication rate after primary and secondary wound closure in subgroup analysis: a)wound complication rate in tumors on the lower extremity- reduction of wound complication rate in all size subgroups. b) Reduction of wound complication rate on tumors of the lower extremity shows the strongest reduction in tumors from 5-10cm, followed by tumors from 10-15cm

Fig. 5

The use of Drainages after sarcoma resections in patients with and without complications: a) duration of drainage use in days, significant reduction of drainage duration in patients without complications, b) total volume of drainage of drainage was significantly higher in patients with complications, c) drainage volume at day of removal was significantly higher in patients with a complication, d) Total drainage volume after resection of different sized tumors, significantly increased drainage secretion after resection of bigger tumors

Fig. 6

Hospitalization of patients with and without wound complications: Patients with complications had an overall longer hospital stay (13,7 days) than patients without wound complications (7,9 days)