Contemporary role of amputation for patients with extremity soft tissue sarcoma.

INTRODUCTION: limb-sparing surgery is the mainstream treatment for primary extremity soft tissue sarcoma (ESTS) at referral centers, following advances in surgical reconstructions and multimodal management. However, amputation is still needed in selected patients and has not yet been described for a ESTS cohort in a contemporary scenario. MATERIAL AND METHODS: consecutive patients who underwent surgery for primary ESTS from 2006 to 2018 were extracted from a prospectively collected database at our reference center. Patients receiving amputation for either primary tumor or local recurrence (LR) after limb-sparing surgery were selected for analysis. RESULTS: Among 1628 primary ESTS, 29 patients underwent primary amputation (1.8%), 22/1159 (1.9%) for upper limb and 7/469 (1.5%) for lower limb ESTS. Patients were mainly affected by grade III FNCLCC (89.6%) of notable dimension (median size 16 cm, IQR 10-24). 65.5% of patients received preoperative treatments (systemic or regional chemotherapy, radiotherapy or chemo-radiation). Secondary amputation for LR was performed after a median of 23 months in 16/1599 patients (1%). Median survival time was 16.2 and 29.6 months after primary or secondary amputation respectively. Factors prompting the need for a primary amputation were most often a combination of multifocal disease, bone invasion and pain or neurovascular bundle involvement and relevant comorbidities, mainly for grade III tumors in elderly patients. CONCLUSION: Contemporary rate of amputation for ESTS at a reference center is extremely low. Still, amputation is required in selected cases with advanced presentations, especially in elderly, frail patients.

Prevalence of Multidrug-Resistant Organism in ICU Burns Patients at Tertiary Care Hospital.

Burns carries a high-risk of mortality and morbidity. This with increased chances of drug-resistant infections makes the management complicated. Hence this study was conducted to find out the prevalence of multidrug-resistant organisms (MDRO) in burns patients admitted to the intensive care unit at a tertiary care hospital. A 2-year retrospective study was conducted where burn patients reporting MDRO were included. Statistical analysis was performed using SPSS version 26 where a P-value < .05 was considered statistically significant. Out of 97 patients, tissue cultures of 65 patients revealed the presence of MDRO in 27 (27.8%) patients. A male predominance (17, 63.0%) was noted with a mean age of 29.0-year-old. Fire burn (15, 55.6%) was reported to be the most common cause of burn with an average of 29.9% of Total Body Surface Area (TBSA) involved. MDR Pseudomonas aeruginosa was the commonest organism reported in 12 (44%) patients. The average length of stay (LOS) was noted to be 11.3 days with a mortality rate of 48.1% (overall, in all MDRO'S infections). Patients who reported MDRO showed a tendency for longer hospitalization with a higher risk of mortality as the TBSA increased. However, in presence of other factors in burns like higher TBSA, inhalation injury and lack of advanced skin substitute these mortality figures, and their association can be debated. Lastly, the implementation of control measures, as basic as hand hygiene, should be partaken to reduce the burden of MDR infections.