Incidence and Predictive Factors of Wound Complications in Pediatric Extremity Bone Sarcoma Patients Following Extirpative Surgery

Introduction: Pediatric bone sarcomas comprise a rare subset of pediatric cancers, with Osteosarcoma (OS) and Ewing sarcoma (ES) accounting for approximately 90%. Patients with metastatic, relapsed, or refractory tumors face poor prognoses. There is a limited understanding of the postoperative wound complications in pediatric bone sarcomas. This study reports the incidence and contributing factors to wound complications following extremity extirpative surgery in OS and ES patients.Methods:Extirpative operations for bone extremity sarcomas at a tertiary pediatric center across 16 years were retrospectively reviewed. Patients were followed for a minimum of 3 months and stratified based on the presence or absence of wound complications post-surgery. The Children’s Oncology Group (COG) classification was used to define wounds, from minor dehiscence/infection (COG 1) to wounds requiring interventions that delayed or changed the systemic treatment/protocol (COG 3). Fisher’s exact and Wilcoxon rank-sum testing were used to compare demographic and clinical characteristics. Logistic regression modeling was used to assess factors predictive of wound complications.    Results:Among 88 patients identified, 69.3% had OS (n=61) and 30.7% had ES (n=27). Median age was 12.5 (IQR:9-15), with 55.7% (n=49) male and 84.9% (n=73) White. 87.5% (77/88) of surgeries were limb salvages while the remaining were amputations (11/88,12.5%). The overall wound complication rate was 40.9% (n=36). Reported COG classifications were COG I (14/36, 38.9%), COG II (3/36, 8.3%), and COG III (19/36, 52.8%). Median time to complication was 30.5 days (IQR: 36.0-49.5). Tibia and fibula sarcomas (67.7%,21/31) were associated with wound complications (p 0.001), whereas femoral sarcomas (72.5%, 29/40) were associated with an absence of wound complications (p 0.001). Wound complications were higher in patients with both orthopedic and plastic reconstruction compared to those without (65.0% vs 35.0%, p 0.01). Tumor size, radiation, and chemotherapy were not associated with wound outcomes. In regression modeling, orthopedic reconstruction alone was associated with 0.17 times lower odds of wound complications compared to plastic reconstruction alone (95% CI: 0.04-0.74).Discussion: Nearly half of pediatric bone extremity sarcoma patients develop postoperative wound complications, often impacting the systemic treatment protocol. Tibia/fibula sarcoma patients and those undergoing both orthopedic and plastic reconstruction are particularly at high risk. Advanced wound planning is crucial for mitigating complications in this vulnerable group. Further research is warranted in larger cohorts to validate our predictive modeling. Understanding the impact of treatment modalities and disparities between limb salvage and amputation surgeries is imperative for improving patient outcomes in this population.References:1. Gallaway KE, Atadja LA, Callan AK. Fever and Systemic Inflammatory Response Syndrome After Wide Resection of Pediatric Bone Sarcomas. J Pediatr Orthop. 2022;42(7):e783-e787. 2. Gallaway KE, Ahn J, Callan AK. Thirty-Day Outcomes following Pediatric Bone and Soft Tissue Sarcoma Surgery: A NSQIP Pediatrics Analysis. Sarcoma. 2020;2020:1283080.