Incidence and Predictive Factors of Wound Complications in Pediatric Extremity Bone Sarcoma Patients Following Extirpative Surgery

Introduction: Pediatric bone sarcomas comprise a rare subset of pediatric cancers, with Osteosarcoma (OS) and Ewing sarcoma (ES) accounting for approximately 90%. Patients with metastatic, relapsed, or refractory tumors face poor prognoses. There is a limited understanding of the postoperative wound complications in pediatric bone sarcomas. This study reports the incidence and contributing factors to wound complications following extremity extirpative surgery in OS and ES patients.Methods:Extirpative operations for bone extremity sarcomas at a tertiary pediatric center across 16 years were retrospectively reviewed. Patients were followed for a minimum of 3 months and stratified based on the presence or absence of wound complications post-surgery. The Children’s Oncology Group (COG) classification was used to define wounds, from minor dehiscence/infection (COG 1) to wounds requiring interventions that delayed or changed the systemic treatment/protocol (COG 3). Fisher’s exact and Wilcoxon rank-sum testing were used to compare demographic and clinical characteristics. Logistic regression modeling was used to assess factors predictive of wound complications.    Results:Among 88 patients identified, 69.3% had OS (n=61) and 30.7% had ES (n=27). Median age was 12.5 (IQR:9-15), with 55.7% (n=49) male and 84.9% (n=73) White. 87.5% (77/88) of surgeries were limb salvages while the remaining were amputations (11/88,12.5%). The overall wound complication rate was 40.9% (n=36). Reported COG classifications were COG I (14/36, 38.9%), COG II (3/36, 8.3%), and COG III (19/36, 52.8%). Median time to complication was 30.5 days (IQR: 36.0-49.5). Tibia and fibula sarcomas (67.7%,21/31) were associated with wound complications (p