Infectious complications and outcomes after limb salvage surgery with vascular reconstruction: A retrospective analysis from a lower middle-income country

Abstract

Objective: Soft tissue sarcomas can involve major blood vessels, historically leading to amputation as the primary treatment. Advances in surgical and vascular reconstruction techniques, along with multidisciplinary care, now allow for limb preservation in selected cases. However, outcomes data from resource-limited countries remain scarce. Therefore, the aim of this study was to assess the infectious, oncological, and functional outcomes of limb salvage surgery with vascular reconstruction in patients with extremity sarcoma.

Methodology: A retrospective review was conducted at Aga Khan University Hospital, Karachi, Pakistan including 29 patients (12 females, 17 males; mean age 34.6 years) who underwent elective sarcoma excision with vascular intervention from 2002 to 2024. All patients had preoperative metastatic screening and MRI to assess tumor extent and vascular involvement. Vascular reconstruction was performed using autologous or synthetic grafts, or primary repair, as appropriate. Outcomes assessed included graft patency, limb perfusion, functional status using Toronto Extremity Salvage Score (TESS), infection and other complications, recurrence and survival

Results: Of the 29 patients, 89.6% had lower limb tumors, predominantly soft tissue sarcomas. Vascular reconstruction was required in 69% of cases. Postoperative arterial patency was 93.1%, and limb salvage was achieved in 82.7%. The mean Toronto Extremity Salvage Score (TESS) was 84.2, with 79% of patients achieving good to excellent function. Complications included wound infections (20.6%), graft infections (6.9%), and thrombosis (6.9%). Local recurrence occurred in 13.8% and distant metastasis in 24.1%. The mean follow-up was 55.2 months, with a 20.7% mortality rate due to metastatic disease. Overall mean survival was 8.6 years while five years survival rate was 73%.

Conclusion: Limb salvage with vascular reconstruction for extremity sarcomas is feasible and effective, offering good functional outcomes. Although postoperative complications may occur but they are manageable with amputation reserved as a last option.