Abstract
Background: Locally advanced malignancies of the upper torso and shoulder girdle (UT-SG) necessitate extensive resection and complex reconstruction. Due to the infrequent nature of these operations, a global reconstructive algorithm has not been defined. Methods: A retrospective review of all patients who received reconstructive surgery following malignant tumor extirpation in the UT-SG from 2008 to 2018 at the University of Texas MD Anderson Cancer Center. Factors predicting the need for flap reconstruction and risk for postoperative complications were evaluated. Results: In total, 252 procedures met inclusion criteria. The most common pathology was sarcoma (76%) and 52% were primary tumors. The median defect area was 112 cm2 (range 4-1350 cm2). Reconstructive techniques included pedicled flaps (46%), local tissue rearrangement (38%), and free flaps (16%). On univariate analysis, the probability of needing a free flap increased 39% when the defect size increased by 100 cm2. The strongest independent predictors of requiring a free flap were major vessel exposure (adjusted odds ratio [OR] = 4.92, 95% confidence interval [CI], 1.36-17.84, P =.015) and major peripheral nerve exposure (adjusted OR = 3.2, 95% CI, 1.1-9.2, P =.031). Conclusion: Despite the aggressive nature of their malignancies, patients requiring an UT-SG resection demonstrate high survival rates and therefore demand a durable reconstruction. Exposed critical structures and defect size were predictive of free tissue transfer.
Original language | English (US) |
---|---|
Pages (from-to) | 283-292 |
Number of pages | 10 |
Journal | Journal of surgical oncology |
Volume | 122 |
Issue number | 2 |
DOIs | |
State | Published - Aug 1 2020 |
Keywords
- algorithm
- flap
- microvascular
- reconstruction
- shoulder
- trunk
ASJC Scopus subject areas
- Surgery
- Oncology