Jarrod T. Bogue

While recent studies have characterized flap-based reconstruction in higher-acuity pediatric extremity tumor cases, the frequency and short-term outcomes of immediate soft-tissue reconstruction across the broader spectrum of pediatric limb-salvage extremity tumor surgery remain poorly defined. The ACS NSQIP-Pediatric database (2012 to 2023) was queried for pediatric upper extremity (UE) and lower extremity (LE) oncologic excisions using comprehensive CPT codes spanning all anatomic levels. We focused exclusively on tumors that required excision and were amenable to limb salvage. Immediate soft-tissue reconstruction was identified by concurrent reconstructive CPT codes. Primary outcomes were wound complications and overall morbidity. We identified 4500 limb-salvage cases (LE, 4295; UE, 205). Bone tumors comprised 94.8% of cases, with 87.7% undergoing simple excisions. Overall, 159/4500 (3.5%) underwent immediate reconstruction, including 134/4295 (3.1%) LE cases and 25/205 (12.2%) UE cases. Complications were more frequent in reconstructed than nonreconstructed cases (44/159, 27.7% vs. 104/4341, 2.4%; P OR =3.48, 95% CI: 1.56-7.75) and ASA III to IV classification ( OR =2.17, 95% CI: 1.18-3.98) were independently associated with 30-day complications. Immediate soft-tissue reconstruction is uncommon in pediatric limb-salvage extremity tumor surgery. In the lower extremity cohort, immediate reconstruction was associated with higher rates of short-term morbidity. However, reconstruction was preferentially used in anatomically and surgically complex cases, and the available data cannot fully account for differences in case complexity. Accordingly, this should not be interpreted as evidence that reconstruction itself increases postoperative risk. These findings provide benchmark data for case selection, perioperative counseling, and future orthoplastic outcomes research.

Purpose Soft-tissue reconstruction following oncologic resection of spinal tumors often leaves extensive dead space vulnerable to infection, cerebrospinal fluid leak, and impaired function. En bloc resection with wide margins remains standard for disease control, but closure of these complex defects is challenging. Plastic and reconstructive surgeons (PRS) are often consulted for soft-tissue closure, yet their role in spinal sarcoma care has not been comprehensively reviewed. We aimed to (1) describe indications and timing of PRS consultation, (2) summarize reconstructive options by anatomic site, and (3) report outcome differences where comparative data were available. Methods Following PRISMA-ScR guidelines, we performed a scoping review of Scopus, PubMed, Embase, Web of Science, and CINAHL databases (January 2000–April 2025). Eligible studies reported spinal sarcoma or mixed oncologic spine cohorts with extractable sarcoma data undergoing flap-based or microvascular reconstruction with postoperative outcome data. Results We included 21 primary studies encompassing 10,854 patients and four secondary sources; two additional narrative reviews published after the original search period were incorporated as contextual sources. PRS teams primarily employed flap-based closure in higher-risk patients, including those with prior irradiation, infection, large posterior defects, or multilevel instrumentation. In comparative observational cohorts, immediate flap-based closure was associated with lower wound complication rates and fewer hardware-related complications. Sacral and chest wall tumors were most anatomically complex, frequently requiring PRS consultation. Conclusion PRS involvement is preferentially utilized in higher-risk settings and is associated with comparable or lower wound morbidity, supporting early PRS consultation when high-risk features are present. These findings support standardized multidisciplinary consultation pathways and future validation of risk stratification tools in this patient population.

Case: A 4-year-old girl with bilateral arthrogrypotic clubfoot underwent posterior release with bilateral V-Y advancement flaps. At 4 months, the patient ambulated independently over moderate distances. One-year follow-up confirmed pain-free functional ambulation, although persistent toe-walking highlighted ongoing neuromuscular challenges and minor correction loss. Conclusion: V-Y advancement flaps provide effective soft tissue coverage after posterior release for arthrogrypotic clubfoot. Early multidisciplinary collaboration integrating orthopedic and plastic surgical planning is essential for optimizing outcomes.

Background: Oncologic lower-extremity sarcoma surgery with flap reconstruction is associated with a high risk of postoperative morbidity. Enhanced Recovery After Surgery (ERAS) protocols have been implemented in various surgical fields to improve postoperative outcomes, but ERAS protocols have not yet been adapted specifically for lower-extremity sarcoma surgery. This scoping review maps ERAS-reported components in the literature on lower-extremity sarcoma reconstruction to inform future protocol development. Methods: We searched PubMed/MEDLINE, Embase, Web of Science, and Cochrane Library from database inception to August 24, 2024, according to PRISMA-ScR guidelines and JBI guidance. Eligible studies assessed patients undergoing lower-extremity sarcoma resection and reconstruction and evaluated ≥1 ERAS-related perioperative component. Data extraction included study design, demographics, flap reconstruction, tumor types, ERAS components, surgical interventions, and primary and secondary postoperative outcomes. Results: The primary search strategy identified 637 articles; 35 studies met the inclusion criteria. Across multiple studies, current smoking and higher preoperative and postoperative glucose levels correlated with higher rates of infection and major wound complications. Prolonged drain duration (≥14 days) was associated with higher surgical-site infection (SSI) rates in one cohort. In the PARITY randomized trial, 24-hour postoperative antibiotic prophylaxis yielded similar SSI rates but fewer antibiotic related adverse events than a 5-day regimen. Conclusions: We mapped commonly reported ERAS components (nutrition optimization, glucose control, multimodal analgesia, drain use, smoking status, antibiotic duration), highlighting evidence signals and identifying existing gaps in the research. Further research is needed to establish lower-extremity sarcoma-specific, evidence-based ERAS pathways.