Large-Defect Resurfacing: A Comparison of Skin Graft Results Following Sarcoma Resection and Traumatic Injury Repair

Masuo Hanada, MD, PhD; Hideki Kadota, MD, PhD; Sei Yoshida, MD; Naohide Takeuchi, MD, PhD; Takamitsu Okada, MD, PhD; Yoshihiro Matsumoto, MD, PhD; Yasuharu Nakashima, MD, PhD


Wounds. 2019;31(7):184-192. 

In This Article

Abstract and Introduction


Introduction: Soft tissue sarcomas are rare neoplasms, and most plastic surgeons do not commonly resurface large tissue defects after a wide resection of these tumors.

Objective: The purpose of this study is to elucidate the clinical results of large skin grafts after wide sarcoma resection by comparison with grafts for traumatic skin defects.

Materials and Methods: A retrospective review was performed of patients who received skin grafts > 50 cm2 after traumatic injury or wide sarcoma resection from 2014 to 2016. Patient medical records were reviewed; graft take rate, graft loss, and days to complete epithelialization were compared between the 2 groups.

Results: In the sarcoma group (n = 8), 5 grafts were partially lost; the sarcoma group mean graft take rate of 67.5% ± 30.0% was significantly lower than that of the trauma group (n = 7) at 99.6% ± 1.1%. The mean time to complete epithelialization from the skin graft placement in the sarcoma group was 113.3 ± 66.0 days, which was significantly longer than that of the trauma group (40.3 ± 38.0 days). Wounds located around the shoulder joint in 2 sarcoma group patients did not heal even after 300 days of conservative treatment; 1 required a secondary flap.

Conclusions: The results of skin grafting for resurfacing large defects after sarcoma resection are inferior to those for traumatic injury repair. Skin grafts may fail because the blood supply for the wound bed is impaired during resection. Furthermore, due to the wound bed movement, epithelialization over muscles of the shoulder joint is difficult to achieve, and skin grafts in this region will likely fail.


Coverage procedures for large soft tissue defects include primary closure, skin grafts (SGs), local flaps, regional flaps, and free tissue transfer. Of these options, skin grafting is a simple, effective procedure for wound coverage commonly used in trauma, wound infection, and resection of skin carcinoma.[1] Skin grafting can also be used for wound coverage after wide resection of soft tissue sarcomas,[2] and adequate soft tissue reconstruction is critical to surgical success.[3,4]

Because sarcoma is a rare carcinoma,[5] patients with a suspected soft tissue or bone sarcoma are generally referred to the regional soft tissue sarcoma unit to be managed by a multidisciplinary team of sarcoma specialists.[6] Therefore, the use of SGs in resurfacing large tissue defects is generally unfamiliar to most physicians except those in the regional units.

The wound bed after sarcoma resection has different characteristics from those of other conditions in which skin grafting is indicated. Because sarcomas arise from subcutaneous or deeper tissues and are excised along with at least 1 to 2 cm of the normal tissue surrounding the tumor, the wound is far deeper than after skin carcinoma removal.[7] There is generally no wound bed preparation in sarcoma resection because, in principle, reconstruction should be achieved as a 1-stage procedure at the time of resection.[2] Resection wounds are made by deliberate, sharp dissection in the operating room and are sterile, unlike wounds from trauma, burn, or infection, which can be contaminated, crushed, and lacerated.

Based on these facts, the authors think skin grafting after sarcoma resection should be given particular attention; however, there is little information about its use in resurfacing large defects. The purpose of this study is to elucidate the characteristics and clinical results of large SGs for the reconstruction of tissue defects resulting from sarcoma resection by comparing them to SGs for traumatic skin defects.