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Outcomes of Limb Salvage Following BrachyVAC Therapy: the University of Pittsburgh Experience
Sivak WN, Ruane EJ, Goodman MA, Weiss KR, Swartz WM, Gusenoff JA, Gimbel ML
University of Pittsburgh
2017-01-27
Presenter: Sivak WN
Affidavit:
Work represents original work of the resident.
Director Name: Vu T Nguyen
Author Category: Resident Plastic Surgery
Presentation Category: Clinical
Abstract Category: General Reconstruction
Purpose: Treating musculoskeletal malignancies with brachytherapy catheters under a VAC device (brachyVAC) facilitates staged reconstruction, avoids radiation of reconstruction, and ensures resection margins. This study reviews our experience with limb salvage after brachyVAC therapy.
Methods: A retrospective review was performed of patients undergoing limb salvage after brachyVAC therapy from 2010-2016. Collected data points included patient demographics/comorbidities, tumor characteristics, treatment specifics, margin status, defect details, reconstructive procedures, complications, and recurrences.
Results: 19 patients were identified (9 male) with average age of 72.7 years. Co-morbidities included hypertension (68.4%), diabetes (31.6%), coronary artery disease (26.3%), and renal insufficiency (26.3%). Smoking (5.3%) and prior radiation (15.8%) were uncommon. Lower extremity tumors (68.4%) were more common than upper extremity (31.6%). Median number of prior resections was one. Clear margins were obtained in 63.2%. Patients began brachytherapy (28-35 Gy over 8-10 fractions) four days (median) after resection. Average defect size was 228.4 cm2 with exposed structures including bone (89.5%), tendon (21.1%), joint (21.1%), nerve (15.8%), and major blood vessel (5.3%). Reconstructions included free flaps (47.4%), pedicled flaps (47.4%) and skin grafts (5.3%) occurring 13 days (median) after extirpation. Major complications include infection (38.5%) and thrombosis/bleeding (23.1%). Recurrence was 41.7% for patients with clear margins at average follow-up of 1.6 yrs. Functional use of the limb was regained in 78.9%.
Conclusions: Reconstruction of musculoskeletal malignancies remains a challenge. Patients regain functional use of the limb in the majority of cases. The frequent tumor recurrences in our study are comparable to other published reports utilizing traditional limb-sparing approaches.
