The Toronto Sarcoma Flap Score: A Validated Wound Complication Classification System for Extremity Soft Tissue Sarcoma F
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ORIGINAL ARTICLE – RECONSTRUCTIVE ONCOLOGY
The Toronto Sarcoma Flap Score: A Validated Wound Complication Classification System for Extremity Soft Tissue Sarcoma Flap Reconstruction Anne C. O’Neill, MBBCh, PhD1,2,3, Me´lissa Roy, MD, MSc1,2,3, Amelia Boucher, MBBCh1,2,3, Aisling M. Fitzpatrick, MD1,2,3, Anthony M. Griffin, MSc2,3, Kim Tsoi, MD, PhD2,3, Peter C. Ferguson, MD, MSc2,3, Jay S. Wunder, MD, MSc2,3, and Stefan O. P. Hofer, MD, PhD1,2,3 1
Division of Plastic and Reconstructive Surgery, Department of Surgical Oncology, University Health Network, Toronto, ON, Canada; 2University Musculoskeletal Oncology Unit, Mount Sinai Hospital, Toronto, Canada; 3Department of Surgery, University of Toronto, Toronto, Canada
ABSTRACT Background. Flap reconstruction plays an important role in limb preservation after wide resection of extremity soft tissue sarcoma (ESTS), but can be associated with high rates of postoperative wound complications. Currently, no standardized system exists for the classification of these complications. This study aimed to develop a standardized classification system for wound complications after ESTS flap reconstruction. Methods. Outcomes of ESTS flap reconstructions were analyzed in a retrospective cohort of 300 patients. All wound- and flap-related complications were identified and categorized. Based on these data, a scoring system was developed and validated with a prospective cohort of 100 patients who underwent ESTS flap reconstruction. Results. A 10-point scoring system was developed based on the level of intervention required to treat each complication observed in the retrospective cohort. Raters applied the scoring system to the prospective patient cohort. Validation studies demonstrated excellent inter-rater and intrarater reliability (weighted Cohen’s kappa range, 0.82 [95% CI, 0.5–1.0] to 0.99 [95% CI, 0.98–1.0] and 0.95 [95% CI, 0.84–1.0] to 0.97 [95% CI, 0.92–1.0], respectively). The majority of the raters reported the score to be simple,
Ó Society of Surgical Oncology 2020 First Received: 20 June 2020 Accepted: 3 September 2020 A. C. O’Neill, MBBCh, PhD e-mail: Anne.O’[email protected]
objective, and reproducible (respective mean scores, 4.76 ± 0.43, 4.53 ± 0.62, and 4.56 ± 0.56 on 5-point Likert scales). Conclusion. The Toronto Sarcoma Flap Score (TSFS) is a simple and objective classification system with excellent inter- and intra-rater reliability. Universal adoption of the TSFS could standardize outcome reporting in future studies and aid in the establishment of clinical benchmarks to improve the quality of care in sarcoma reconstruction.
Soft tissue sarcomas are a group of rare heterogeneous neoplasms that account for less than 1% of all cancers.1 These tumors most commonly affect the extremities, and in the past, amputation frequently was required to achieve local disease control. However, advances in imaging, surgical techniques, and adjuvant therapies currently permit limb preservation in the majority of cases.2 Flap reconstruction plays a very important role in this proce
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