Can endothelial cell dysfunction decide surgical wound health in bone sarcoma? Prospective study evaluating factors predicting wound complications in sarcoma.

Background: This prospective study aims to explore the role of endothelial dysfunction in impaired wound healing following limb salvage procedures in patients with bone sarcomas. We propose that dysfunction of the vascular endothelium may significantly contribute to postoperative wound-related issues in these cases. Methods: Forty-six patients (34 males, 12 females; mean age 19.73 ± 11.51 years, range 3-57) were enrolled. Diagnoses included Ewing's sarcoma (n = 22), Osteosarcoma (n = 19), Chondrosarcoma (n = 3), and Synovial sarcoma (n = 2). Endothelial function was assessed using flow-mediated dilatation (FMD) of the brachial artery. Patients were stratified into two groups-those with normal wound healing and those with postoperative complications-to evaluate contributing factors. Results: Wound complications occurred in 5 patients (10.8 %). Univariate analysis showed significant associations with FMD values, postoperative drain output, and transfusion volumes. Multivariate regression identified FMD as the only independent predictor of wound healing (P = 0.005; OR = 0.450; 95 % CI: 0.259-0.782). Conclusion: FMD may serve as a reliable surrogate marker for vascular endothelial health and thus aid in forecasting postoperative wound healing issues. Assessing endothelial function preoperatively could enhance risk stratification and open avenues for targeted interventions.