Thursday, October 16, 2014

Simple test may predict wound complications after soft tissue sarcoma surgery

MAYWOOD, Ill. (Oct. 16, 2014) - As many as 35 percent of patients who undergo surgery to remove soft tissue sarcomas experience wound-healing complications due to radiation they receive before surgery.

Now a study suggests that a simple test called transcutaneous oximetry may be able to predict which of these patients are most likely to experience wound-healing complications, potentially enabling surgeons to take extra precautions.
Lukas Nystrom, MD, of Loyola University Medical Center, presented his findings during the 2014 annual meeting of the Musculoskeletal Tumor Society. Dr. Nystrom received the society’s New Investigator Award for the study.

Soft tissue sarcomas are cancers that originate in the soft tissues, such as muscles, fat, blood vessels, nerves and tendons. External beam radiation typically is part of the treatment regimen. Patients often do better and require less radiation when it is administered before surgery, but doing this also increases the risk of wound-healing complications.

Transcutaneous oximetry is a noninvasive test that measures the oxygen level of tissue beneath the skin. Adhesive sensors with oxygen-detecting electrodes are placed on the skin. The test causes no side effects or discomfort to the patient.

The study followed 10 patients who underwent surgery for soft tissue sarcomas after receiving radiation treatment. Patients with lower transcutaneous oxygen levels before surgery were more likely to experience wound complications. Four of the seven patients who had levels lower than 25 mm Hg just before surgery experienced wound complications, while all three patients with oxygen levels higher than 25 mm Hg healed without difficulty.

Dr. Nystrom noted that the study population is small and further work is necessary to confirm the findings. If confirmed by further study, transcutaneous oximetry potentially could become a tool to predict which patients are most at risk for wound complications. Extra precautions then could be taken to prevent complications, such as increasing the time between radiation and surgery and performing additional tissue transfers and vacuum-assisted closure, Dr. Nystrom said.

The study was performed at the University of Iowa Hospitals & Clinics, where Dr. Nystrom completed  his residency. The co-author is Benjamin Miller, MD, of the University of Iowa.

“Transcutaneous oximetry represents a potential tool for decisions regarding surgical timing or potentially other medical and surgical efforts to diminish wound complications,” Drs. Nystrom and Miller concluded. “However, given this small sample size more data is needed to further assess the relationship.”
Drs. Nystrom and Miller are applying for funding to conduct a prospective, multicenter study to confirm these findings. Loyola would serve as the primary study site.

Dr. Nystrom is an orthopaedic oncologist, specializing in the treatment of benign and malignant tumors of the bone and soft tissues. He is an assistant professor in the Department of Orthopaedic Surgery & Rehabilitation at Loyola University Chicago Stritch School of Medicine.

About Loyola University Health System

Loyola University Health System (LUHS) is a member of Trinity Health. Based in the western suburbs of Chicago, LUHS is a quaternary care system that includes Loyola University Medical Center (LUMC), located on a 61-acre campus in Maywood, Gottlieb Memorial Hospital (GMH), on a 36-acre campus in Melrose Park, and convenient locations offering primary and specialty care services throughout Cook, Will and DuPage counties. At the heart of LUMC is a 547-licensed-bed hospital that houses the Center for Heart & Vascular Medicine, the Cardinal Bernardin Cancer Center, a Level 1 trauma center, a burn center, a children's hospital, Loyola Outpatient Center, and Loyola Oral Health Center. The campus also is home to Loyola University Chicago Stritch School of Medicine, Loyola University Chicago Marcella Niehoff School of Nursing and the Loyola Center for Fitness. The GMH campus includes a 254-licensed-bed community hospital, a Professional Office Building with 150 private practice clinics, an adult day care program, the Gottlieb Center for Fitness, the Loyola Center for Metabolic Surgery and Bariatric Care and the Loyola Cancer Care & Research at the Marjorie G. Weinberg Cancer Center at Melrose Park.

Trinity Health is one of the largest multi-institutional Catholic health care delivery systems in the nation. It serves people and communities in 22 states from coast to coast with 93 hospitals, and 120 continuing care locations — including home care, hospice, PACE and senior living facilities — that provide nearly 2.5 million visits annually.