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Orthopedic & Reconstructive Surgery

(P 488) POSTOPERATIVE DRAINAGE MANAGEMENT AND WOUND COMPLICATIONS FOLLOWING RESECTION OF LOWER LIMB SOFT TISSUE TUMORS

Location: The Liffey, Level 1

    Co-Author(s)

  • AG

    Andreas Gerken, MD

    University Medical Center Mannheim
    Mannheim, Baden-Wurttemberg, Germany

  • Philipp Jawny, MD

    Resident
    Department of Cardiothoracic Surgery, University Hospital Augsburg
    Augsburg, Bayern, Germany

  • HW

    Helene Weigl, MD (she/her/hers)

    Oncological Surgeon
    University Medical Center Mannheim
    Mannheim, Baden-Wurttemberg, Germany

  • Franka Menge

    Dr.
    Sarcoma Unit, Department of Surgery and Mannheim Cancer Center, University Medical Center Mannheim, University of Heidelberg, Mannheim,Germany
    Mannheim, Baden-Wurttemberg, Germany

  • CW

    Christel Weiß, PhD

    University Medical Center Mannheim
    Mannheim, Baden-Wurttemberg, Germany

  • PH

    Peter Hohenberger, N/A, n/a

    Sarcoma Unit, Department of Surgery and Mannheim Cancer Center, University Medical Center Mannheim, University of Heidelberg, Mannheim,Germany
    Mannheim, Baden-Wurttemberg, Germany

    • Author(s)

  • Jens Jakob, MD (he/him/his)

    Prof.,
    University Medical Center Mannheim, University of Heidelberg
    Mannheim, Baden-Wurttemberg, Germany

Objective: Postoperative wound complications are common in sarcoma surgery. Postoperative drainage therapy may indicate postoperative bleeding and support wound healing by avoiding seroma but may also cause complications such as secondary infection. Prolonged drainage therapy may delay adjuvant treatment and rehabilitative measures. The aim of this study was to evaluate the incidence of postoperative wound complications and delayed or prolonged drainage treatment in lower limb tumors.

Methods: A retrospective analysis of 80 patients who underwent primary resection of lower extremity soft tissue tumors was performed. Wound complications (e.g. infection), known risk factors for wound complications (e.g. large tumor size) as well as postoperative drainage management were documented. A classification of postoperative wound complications was developed. The classification took into account prolonged drainage management.

Results: The proposed classification of postoperative wound complications taking into account draiange management is depicted in table 1. A so-called regular postoperative course (grade 0) was documened in 33% of all patients. Minor wound complications or delayed drainage removal (grade A) occured in 15%. Major wound complications or prolonged drainge therapy (grade B) and reoperations (grade C) were documented in 39% and 13%.Tumor size (p = 0.0004), proximal tumor location (p = 0.0484), and tumor depth (p = 0.0138) were identified as risk factors for complex postoperative courses (grade B or C). Drainage volume on postoperative day 4 was a suitable predictor for complex courses (cutoff of 70 ml/d).

Conclusion: We confirm a high rate of postoperative complications after surgery for lower extremity tumors. We propose to include prolonged drainage management into aclassification of postoperative wound complications to take into account the increased need for inpatient as well as outpatient care for the affected patients including the delay of adjuvant treatment and rehabilitative measures. We propose drainage volume on day 4 as a predictor for a complex postoperative course.