Transcutaneous Oxygen as a Predictor of Wound Healing Complications in Preoperatively Radiated Soft Tissue Sarcoma

It is estimated that there are 11,400 new cases of soft tissue sarcoma diagnosed in the

United States annually. Most high-grade sarcomas, and other selected low or intermediate

grade sarcomas, are treated with a limb salvage surgical resection in conjunction with

external beam radiation to optimize local control. The current preference of most

practicing orthopaedic/surgical oncologists and radiation oncologists is to implement the

radiation treatments prior to surgery to diminish the total radiation dose and field

size, thereby optimizing long-term functional results of the salvaged limb. While there

are clear advantages of preoperative radiation, there are well-demonstrated negative

consequences with regard to healing of the surgical wound. Currently there are no

reliable clinical criteria to aid physicians in determining an individual patient's risk

of developing a postoperative wound complication. This fact, combined with the rarity of

the sarcoma diagnosis, has prevented improvement in wound outcomes in sarcoma patients.

This project is designed to close this critical gap in knowledge. The investigators

propose utilizing a preoperative measurement of transcutaneous oxygen (Tc02) at the

proposed incision to classify patients into high- and low-risk categories for development

of wound complications after resection. Measurement of preoperative TcO2 represents a

novel application of a simple, noninvasive method by which to assess skin oxygenation.

Given the results of an already completed pilot investigation (Nystrom 2016), the

investigators believe that this important clinical problem is well suited for a

prospective, multi-disciplinary, multi-institutional investigation.

A successful project would result in an enhanced ability to identify wounds at risk prior

to surgery and allow for additional investigation into perioperative interventions (delay

of surgery until recovery of oxygenation, increasing suture duration, judicious use of

muscle flaps and skin grafts, postoperative hyperbaric oxygen, or treatment with

incisional wound vacuum-assisted closure) that may mitigate this significant adverse

outcome.