Impact of Technological Advancements on Short-term Outcomes in Flap Reconstruction after Soft Tissue Sarcoma Resection: A Retrospective Comparative Analysis.

Background:  Soft tissue sarcomas (STS) are rare malignancies requiring extensive surgical resection, often leading to significant soft tissue defects. Flap reconstruction is crucial for restoring function and appearance. Recent reconstructive microsurgery advancements, including high-resolution indocyanine green (ICG) imaging and ultra-high frequency ultrasonography (UHFU), have revolutionized preoperative planning and intraoperative guidance. We aimed to compare the surgical procedures and short-term outcomes of patients undergoing immediate flap reconstruction before and after our department's adoption of these technologies.

Methods:  We retrospectively analyzed 276 patients who underwent immediate flap reconstruction post-sarcoma resection between May 2014 and December 2023. They were categorized into pre- and post-technology groups based on the introduction of ICG angiography and UHFU in July 2019. We collected demographic, surgical, and postoperative data and compared outcomes using Fisher's exact and t-tests.

Results:  The muscle preservation rate at the donor site was significantly higher in the post-Tech than in the pre-Tech group (no muscle damage: 65% vs. 37%, incision muscle damage: 25% vs. 26%, and muscle resection: 10% vs. 37%; p < 0.01). The proportions of complications (21% vs. 36%, p = 0.01), flap complications (17% vs. 30%, p = 0.01), partial flap loss (5% vs. 17%, p < 0.01), and flap dehiscence (9% vs. 25%, p < 0.01) were low in the post-Tech group. In the stratified analysis of free-flap reconstruction, the post-Tech group had a shorter operative time (7:01 vs. 8:13, p = 0.03) and fewer takebacks due to compromised flap perfusion (4% vs. 15%, p = 0.03) compared with the pre-Tech group.

Conclusion:  The introduction of ICG angiography and UHFU has improved surgical outcomes in STS flap reconstructions. These technologies facilitate precise preoperative planning and intraoperative decision-making, resulting in reduced operative times, low complication rates, and enhanced muscle preservation at the donor site.