RESUMO
Background: Radiotherapy is considered a cornerstone as adjuvant or neo adjuvant to surgery in extremity soft tissue sarcoma (ESTS). Wound complications are the most agonizing complication that may have an impact on patient's functional outcome following radiotherapy. The best care for ESTS is by combining extensive surgical excision with safety margin and radiotherapy either preoperative (neoadjuvant) or postoperative. Preoperative radiotherapy allows for lower dose of radiation over smaller fields which is supposed to decrease long-term complications. However, several studies have shown that early complications which include wound dehiscence, infection, seroma and burn may be more frequent with preoperative radiotherapy than with postoperative radiotherapy. Most of these studies were retrospective. This study aims to prospectively assess and compare the early complications associated with radiotherapy in both techniques. Hypothesis: Preoperative radiotherapy is not inferior to postoperative radiotherapy regarding early wound complications. Patients and methods: Between January 2021 and June 2022, we prospectively studied 22 patients and categorized them into two groups, group A (preoperative radiotherapy) and group B (postoperative radiotherapy). We included patients with extremity soft tissue sarcoma in skeletally mature patients who were randomized into two groups with follow up 9-12 months. Wound complications, local complications, recurrence, time for wound healing and survival rate were recorded and analyzed using SPSS 25. Results: 22 patients were included, 10 in group A and 12 in group B, their mean age was 46.4 years with mean follow up 9 months. The major wound complications were higher in group A (preoperative radiotherapy). in comparison with group B (postoperative radiotherapy), however, this was not statistically significant. While other local complications were higher in group B, it was also statistically insignificant. Time for wound healing was higher in group A more than group B and was statistically significant (p value = 0.011). Conclusion: No increase in the wound complications rate with preoperative radiotherapy by using low fractionated doses of radiotherapy and increasing interval before surgery to six weeks, although there is increased risk of delayed wound healing time after surgery. The size and site of the tumor may increase the risk of wound complications unrelated to the type of radiotherapy. Level of evidence: II: clinical trial.
RESUMO
INTRODUCTION: Using non-vascularized fibula as autogenous graft has gained much success in reconstruction after tumor resection owing to its simplicity. Donor-site morbidity related to fibula deficiency includes valgus ankle, chronic pain and stress fractures of the ipsilateral tibia. HYPOTHESIS: Growth potential before skeletal maturity is the most important factor promoting fibular regeneration after non- vascularized harvesting, and its decline with skeletal maturity causes failure of fibular regeneration. PATIENTS AND METHODS: This is a retrospective study of the patients with benign bone tumors who required bone defect reconstruction by non-vascularized fibular graft utilizing a periosteal preserving technique. The study entailed 118 patients below the age of 12, 100 age 12-18, and 80 above the age of 18. RESULTS: In children below 12, regeneration was complete in 95%, incomplete in 4.2% and partial in 0.8% of the cases. In adolescents, regeneration was complete in 72%, incomplete in 15% and partial in 13% of the cases. After skeletal maturity, no regeneration occurred in 92.5%of the patients, while partial regeneration occurred in 7.5% of the cases. Valgus ankle occurred in 2.8% of the cases before skeletal maturity, and none in older patients. DISCUSSION: Complete regeneration after non-vascularized fibula graft harvesting is the rule in pediatric patients and to a lesser extent in adolescent group. This is usually associated by near normal regaining of the regenerate strength and function. Non-regeneration dominates in older age group. The length of the harvested segment has no impact on the regeneration or the remodeling process. LEVEL OF EVIDENCE: IV; case series, retrospective comparative study.
