Effect of intensive adjuvant chemotherapy on wound healing in 69 patients with osteogenic sarcomas of the lower extremities.

Reported surgical adjuvant trials in humans have resulted in little clinically significant impairment of wound healing. Such trials are often carried out with subtherapeutic doses or with the drugs administered relatively late in the wound healing process. It is the objective of our study to investigate the effect of intensive pre- and postoperative chemotherapy (BCD, ADR, HD-MTX) on wound healing in patients with osteogenic sarcomas. Wound healing was defined in our study as lack of infection. In a series of 110 patients with osteogenic sarcomas we analyzed the data of 69 patients with lower extremity lesions: of these, 54 patients had distal femur lesions and 15 had upper tibia and fibula lesions. All the patients underwent en-bloc resections and insertion of a prosthetic device. Pre- and postoperative antibiotics were given routinely. In 80% of our patients (55/69) an uneventful postoperative course was recorded with respect to wound healing. None of these required a secondary operative procedure. Débridement of the wound or débridement of the wound followed by skin grafting had to be performed in 14% (10/69) of the patients. Most of the amputations were performed early in this series of cases. After secondary surgery wound healing was uneventful in most of the patients. No patient died as a consequence of wound infection. Mixed bacterial infections were found in 13/14 patients. No single specific bacterium could be identified. One patient developed a fungal infection (aspergillosis). Eight infections were secondary to skin necrosis. In this series we later found the serious effects of the skin necrosis and slough could be reduced by early intervention with a muscle pedicle flap.(ABSTRACT TRUNCATED AT 250 WORDS)