(P 402) TISSUE PERFUSION AND WOUND HEALING AFTER SOFT TISSUE SARCOMA RESECTION

Objective: Soft tissue sarcoma is a rare but potentially lethal malignancy with an incidence of 12,750 in 2019 alone. Because of the complex nature of these tumors, surgical resection in combination with radiation therapy is the mainstay of treatment. While the benefits of this dual treatment have been proven, radiation also has well-described negative consequences on long-term tissue integrity and wound healing. An estimated 35% of all patients that receive preoperative radiation experience wound complications. However, outside the known comorbidities such as smoking and diabetes that impair wound healing, there are no reliable clinical criteria that can predict wound complications in patients. It has been suggested that wound healing potential in sarcoma can be evaluated using intraoperative indocyanine green fluorophore (ICG) fluorescence imaging to assess perfusion. Therefore, we aim to investigate the association between tissue perfusion and wound outcomes after resection of soft tissue sarcoma. This is a preliminary report of an investigation that is ongoing.

Methods: This is a prospective clinical study. Patients with biopsy-proven soft tissue sarcoma who were to be treated with limb-sparing surgical excision and primary skin closure were prospectively enrolled. Utilizing Near-infrared fluorescent imaging (NIRF), a video sequence of intravenous ICG was recorded intraoperatively. These videos were recorded at 3 points intraoperatively: before tumor resection, after resection, and after wound closure. From these videos, perfusion-time graphs were generated which correlate fluorescence intensity to tissue perfusion. Patients are then followed for 6 months postoperatively to assess for wound complications. The postoperative wound during follow-up in every patient was compared to the perfusion curves generated intraoperatively. Wound complication was the primary outcome of interest which was subdivided into: drainage/delayed healing, necrosis, dehiscence, seroma, hematoma, superficial and deep infection, each of these with its own annotation.

Results: To date, 25 of the planned 40 patients have been enrolled and 18 have been analyzed. Most tumors were located in the thigh (61.1%). Myxofibrosarcoma (27.8 %) was the most common histology. 15 patients (83.3%) received preoperative radiation. 10 patients (55.6%) experienced wound complications with 5 (50 %) requiring return to OR (Table 1). While some patients’ perfusion-time curves showed a clear distinction between the different annotations (Figure 1), this was not consistent across every patient who experienced wound complications. We also observed some differences in the parameter mapping showing ICG ingress and area under the curve (AUC). Data collection and analysis are ongoing.

Conclusion: Intraoperative assessment of tissue perfusion may provide predictive insight into wound healing potential. This investigation is ongoing.