BackgroundThe reconstructive ladder relies mostly on defect size and depth to determine reconstructive technique, however, in actuality, many more variables ultimately inform reconstructive decision making, especially regarding extremity soft tissue sarcoma (eSTS) defects. The purpose of this study was to describe eSTS patients who will most optimally benefit from an advanced method of reconstruction (defined as a pedicled regional flap or free flap) and to create a simple risk assessment scale that can be employed in clinical practice.Study DesignA single‐institution retrospective cohort study examined patients undergoing resection of soft tissue sarcoma affecting the upper or lower extremities between 2016 and 2021. We categorized patients who required a pedicled or free flap as having had advanced reconstruction, and all other techniques were considered simple reconstruction. A regression was used to create a risk scale to guide reconstructive decision‐making.ResultsThe following variables were identified as independent predictors of complications and used to create our risk scale: lower extremity tumor location, preoperative radiotherapy, tumor bed excision, male sex, hypertension, and tumor volume. Intermediate and high‐risk patients reconstructed using simple techniques had significantly greater overall complication rates compared to those reconstructed with advanced techniques. Major complications were significantly greater in low‐risk patients reconstructed with advanced techniques.ConclusionsTo minimize postoperative wound complications, low‐risk patients should receive simple methods of reconstruction, whereas high‐risk patients should be reconstructed using advanced techniques.

中文翻译：

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何时放弃梯子并乘坐电梯：安德森肉瘤并发症风险 (A-SARC) 评分指导四肢软组织肉瘤患者的重建决策

背景重建阶梯主要依赖于缺损的大小和深度来确定重建技术，然而，实际上，更多的变量最终影响重建决策，特别是关于四肢软组织肉瘤（eSTS）缺损。本研究的目的是描述最能从先进的重建方法（定义为带蒂区域皮瓣或游离皮瓣）中受益的 eSTS 患者，并创建一个可用于临床实践的简单风险评估量表。 研究设计A单机构回顾性队列研究检查了 2016 年至 2021 年间接受上肢或下肢软组织肉瘤切除术的患者。我们将需要带蒂或游离皮瓣的患者归类为高级重建，所有其他技术均被视为简单重建。使用回归创建风险量表来指导重建决策。结果以下变量被确定为并发症的独立预测因子，并用于创建我们的风险量表：下肢肿瘤位置、术前放疗、瘤床切除、男性、高血压和肿瘤体积。与采用先进技术重建的患者相比，使用简单技术重建的中危和高危患者的总体并发症发生率显着更高。采用先进技术重建的低风险患者的主要并发症明显较多。结论为了尽量减少术后伤口并发症，低风险患者应采用简单的重建方法，而高风险患者应采用先进技术重建。