1. Rate of wound healing complications in patients with sarcoma excision and flap reconstruction. Mr. Paul Wilson. Mohamed Maklad.

2. Protocol of sarcoma management ▪ Radiotherapy Usually preoperative to achieve maximum tumour necrosis before surgery. Occasionally, postoperative radiotherapy. Usually 25 sessions over 5 weeks each is 50 Gy. ▪Wide local excision of the tumour Within 3-4 weeks after radiotherapy. The window gap between radiation induced vessel disease and recovery of acute skin changes.

3. 3 ▪Flap reconstruction ( Rationale of the principle) 1- Discard irradiated skin including biopsy site. 2- Obliterate dead space. 3- protect exposed underlying vital structures e.g. Femoral vessels. 4- Improve vascularity.

4. Background. The rate of wound healing complications in patients with direct closure after sarcoma excision : 1- with preoperative radiotherapy >>>> 35% of patients get wound healing issues. 2- with postoperative radiotherapy>>>> NO great difference as preoperative radiotherapy. 3- Patients who did not have any radiotherapy>>>> 17% of them get wound healing complications.

5. Aim of the audit. To compare rate of wound healing complications between direct closure Vs flap reconstruction after excision of sarcomas.

6. Methods. ▪Wound complication is defined as: 1- prolonged hospital stay for complicated wound. 2- Re admission to theatre to manage wound complication. ▪Data collection: 1- Retrospective study. 2-patients notes. 3-Data from oncology team in BRI. 4- The audit included 51 patients operated between 2011 and 2015.

7. Results ▪Radiotherapy: 1-39 patients received radiotherapy either preoperatively or postoperatively. 2- 12 patients did not receive any radiotherapy. ▪Flaps: 1- 20 free flap mainly ALT and LD. 2- 21 regional flaps e.g. gastrocnemius, VRAM and LD. 3- 10 local skin flaps.

8. 8 ▪Complications rate: 1-Patients who received radiotherapy (39), only 5 patients had complications 12.8%. 2- Patients who did not receive any radiotherapy (12), ONE patient had complications.

9. 9

10. Conclusion. ▪Using flaps dramatically decreases the risk of wound healing problems in patients who undergo sarcoma excision, whether they receive radiotherapy or not.

11. Thank you