Osteosarcoma is a highly malignant bone tumor, and a subset of cases is closely associated with hereditary syndromes. These syndrome-related osteosarcomas exhibit unique clinical features, molecular mechanisms, and therapeutic challenges. This review summarizes the current understanding of specific types of syndrome-related osteosarcomas, including those associated with Rothmund-Thomson syndrome, Li-Fraumeni syndrome, secondary osteosarcoma in retinoblastoma survivors, Werner syndrome, and Bloom syndrome. These syndromes are typically characterized by specific gene mutations or chromosomal instability, significantly increasing the risk of osteosarcoma development. However, the rarity and heterogeneity of syndrome-related osteosarcomas pose significant challenges for diagnosis and treatment, including difficulties in early detection, incomplete elucidation of molecular mechanisms, and limitations of conventional therapeutic approaches. This article aims to systematically review the clinical characteristics, molecular mechanisms, and therapeutic challenges of these syndromes, providing a comprehensive reference for clinicians and directions for future research.

BACKGROUND AND OBJECTIVE:Although pedicled flaps are widely used in trunk reconstruction, evidence remains limited regarding their efficacy in patients with soft tissue sarcoma (STS) requiring wide resection with skeletal involvement. METHODS:This retrospective cohort study analyzed 42 consecutive patients who underwent pedicled flap reconstruction after trunk sarcoma resection at our institution (2019-2024). Flap types included 30 fasciocutaneous and 12 myocutaneous flaps. Outcomes included flap survival (photographic/Doppler assessment) and complications (Clavien-Dindo). Statistical analysis was performed using the Fisher's exact test and Kaplan-Meier methods (SPSS v26). RESULTS:The cohort demonstrated favorable outcomes with pedicled flap reconstruction (92.86% primary healing rate). Among skeletal defect cases, reconstructions used soft prostheses (n = 6), rigid prostheses (n = 2), or mesh reinforcement (n = 2). During the 11-59 month follow-up period, distant metastases developed in 14.29% of cases (3 pulmonary, 2 hepatic, and 1 peritoneal) (5 pulmonary, 2 pulmonary and hepatic, and 1 peritoneal). CONCLUSION:Our findings suggest that pedicled flap reconstruction following wide resection of trunk soft tissue sarcomas is associated with satisfactory outcomes (92.9% primary healing rate) and low major complication rates (7.1% Grade I-II complications). These results indicate that pedicled tissue flaps represent a viable reconstructive option when tumor clearance can be achieved.

Introduction: Few studies have focused on the risk factors for hidden blood loss (HBL) during cement augmentation surgery for pathologic vertebral compression fraction (PVCFs). Method: From January 2014 to December 2020, the clinical data of 169 PVCF patients (283 levels) who underwent cement augmentation were retrospectively analysed. HBL was calculated according to the linear Gross formula using the patient's average Hct during the perioperative course and PBV. Multivariate linear regression analysis was performed to evaluate the independent factors associated with HBL. Results: The mean HBL was 448.2 ± 267.2 ml, corresponding to 10.8% ± 6.2% of the patient blood volume (PBV). There were significant differences between pre- and postoperative haematocrit (Hct) (P < 0.001) and Hb (P < 0.001), and 132 patients developed anaemia postoperatively, while 79 patients had anaemia preoperatively (P < 0.001). Multivariate linear regression revealed that bone lesion quality (p = 0.028), number of PVCFs (p = 0.002), amount of bone cement (p = 0.027), bone cement leakage (p = 0.001), and percentage of vertebral height loss (VHL) (p = 0.011) were independent risk factors for HBL. Conclusion: In conclusion, patients with lytic vertebral destruction, larger amounts of bone cement, greater amounts of bone cement leakage, more PVCF(s), and greater percentages of VHL may be more prone to HBL.

皮肤恶性黑色素瘤(CMM)是皮肤来源的高度恶性肿瘤,发病率不高,但恶性程度高,致死率高,早期可发生转移.准确地判定肿瘤分期并行规范的治疗可明显改善预后,提高患者生存率.外科手术仍是CMM治疗的基础.随着分子检测的开展,靶向和免疫等精准治疗的快速进展,局部不可切除或晚期的CMM治疗显著获益,但仍需继续探索.本文就近年来对该病的治疗研究进展作如下综述.

BACKGROUND:DICER1-AS1 is reported to promote the progression and disturb the cell cycle in osteosarcoma; however, its mechanism has rarely been studied.MATERIALS AND METHODS:DICER1-AS1 expression levels were evaluated by qPCR and fluorescence in situ hybridization (FISH). The total, nuclear, and cytosolic levels of CDC5L were measured by western blotting and immunofluorescence (IF). Cell proliferation, apoptosis, and cell cycle analyses were conducted using the colony formation, CCK-8 assay, terminal transferase-mediated UTP nick end-labeling kit (TUNEL) assay, and flow cytometry. Levels of cell proliferation-, cell cycle-, and cell apoptosis-related proteins were determined by western blotting. RNA immunoprecipitation (RIP) and RNA pull-down assays were conducted to evaluate the relationship between DICER1-AS1 and CDC5L.RESULTS:LncRNA DICER1-AS1 was highly expressed in samples of osteosarcoma tissue and in osteosarcoma cell lines. DICER1-AS1 knockdown inhibited cell proliferation, promoted cell apoptosis, and disturbed the cell cycle. Moreover, DICER1-AS1 was found to bind with CDC5L, and knockdown of DICER-AS1 inhibited the nuclear transfer of CDC5L. DICER1-AS1 knockdown also reversed the effects of CDC5L overexpression on cell proliferation, apoptosis, and the cell cycle. Moreover, CDC5L inhibition suppressed cell proliferation, promoted cell apoptosis, and disturbed the cell cycle, and those effects were further enhanced by DICER1-AS1 knockdown. Finally, DICER1-AS knockdown inhibited tumor growth and proliferation, and promoted cell apoptosis in vivo.CONCLUSION:LncRNA DICER1-AS1 knockdown inhibits the nuclear transfer of CDC5L protein, arrests the cell cycle, and induces apoptosis to suppress the development of osteosarcoma. Our results suggest a novel target (DICER1-AS1) for treatment of osteosarcoma.

The management of sarcomas, a diverse group of cancers arising from connective tissues, presents significant challenges due to their heterogeneity and limited treatment options. Patient-derived sarcoma organoids (PDSOs) have emerged as a promising tool in the multimodal management of sarcomas, offering unprecedented opportunities for personalized medicine and improved treatment strategies. This review aims to explore the potential of PDSOs as a promising tool for multimodal management of sarcomas. We discuss the establishment and characterization of PDSOs, which realistically recapitulate the complexity and heterogeneity of the original tumor, providing a platform for genetic and molecular fidelity, histological resemblance, and functional characterization. Additionally, we discuss the applications of PDSOs in pathological and genetic evaluation, treatment screening and development, and personalized multimodal management. One significant advancement of PDSOs lies in their ability to guide personalized treatment decisions, enabling clinicians to assess the response and efficacy of different therapies in a patient-specific manner. Through continued research and development, PDSOs hold the potential to revolutionize sarcoma management and drive advancements in personalized medicine, biomarker discovery, preclinical modeling, and therapy optimization. The integration of PDSOs into clinical practice can ultimately improve patient outcomes and significantly impact the field of sarcoma treatment.

Background An imperative need for better management strategies to improve the survival in patients with undifferentiated pleomorphic sarcoma (UPS). Methods The retrospective analysis of clinicopathological data of 166 UPS patients, who have undergone surgical treatment in our hospital, was carried out from January 2005 to January 2018. Cox regression model and Kaplan-Meier method were employed to identify the relevant factors affecting the rate of local recurrence (LR), distant metastasis (DM), and overall survival (OS) via univariate and multivariate analysis. The P<0.05 were found to be statistically considerable. Results At the end of follow-up, the rate of LR, DM and OS in 166 UPS patients was 22.9% (38/166), 32.5% (54/166) and 75.3% (125/166) with a median follow-up time of 55 months. The existing study reveals that the UPS in trunk, tumor size ≥5 cm and R1/R2 resection margin are the prognostic markers of poor survival rate. Women are more susceptible to LR, and R1/R2 resection margin is significantly correlated with a high rate of LR. Old Patients (>60 years), the UPS in trunk and R1/R2 resection margin are susceptible to DM. Conclusions R0 resection margin was an only independent favorable prognostic factor, which was correlated with LRFS, DMFS, and OS.

Background: No reliable predictive models for distant metastasis in extremity undifferentiated pleomorphic sarcoma (UPS) had been reported.Method: A retrospective data mining study was conducted in 166 patients of extremity UPS from January 2005 to August 2018 in a single center. Using Python 3.7.3 (Windows x64 version) for data modeling and statistical analysis based on scikit learn framework, to evaluate patients' demographic and tumor characteristics, preoperative examination, pathology, chemotherapy and other datasets. Four models were applied to this predictive model including adaptive boosting (AdaBoost), support vector machine, random forest and logistic regression.Results: AUCs of AdaBoost, SVM, and LR are all over 0.8 and are 0.8585 (p<.001), 0.8341 (p<.001) and 0.8285 (p<.001), respectively. The difference of recall rate is obvious among the four algorithms, in which AdaBoost is the best (0.611), support vector machine and random forest are the next, and logical regression is the worst (0.111). These three models showed better ability of distinguishing and prediction. According to the feature importance of the Adaboost model, the top three predictors of distant metastasis in UPS are age of initial treatment, postoperative chemotherapy, and tumor size.Conclusion: It is feasible to predict the distant metastasis in extremity UPS patients by using ML-based models, in which Adaboost performed best. Comparing with conventional models, the machine learning models showed significantly better performance. The age of initial treatment, postoperative chemotherapy, and tumor size are related to distant metastasis of UPS.

Background: Few studies have focused on the correlation between the clinical variables and the survival in Epithelioid Sarcoma (ES). The aim of this study was to investigate the relevant clinical variables influencing the survival of ES patients. Methods: From March 2000 to April 2018, 36 patients (median age, 38 years, range 22–61 years) with ES were evaluated, treated, and followed up. Results: All 36 patients underwent resection in our hospital. Among them, the 2 and 5 years local recurrence rates were 32.0% and 45.1%, respectively, with a better prognosis in patients with R0 resection margin. Distant metastasis rates for the 33 patients with M0 after 2 and 5 years were 51.5% and 70.8%, respectively. Overall survival rates at 2 and 5 years for 36 patients were 74.8% and 43.3%, respectively. Tumor size (>5 cm) and M1 were significantly associated with a poor overall survival. But the R0 resection margin was the only prognostic factor for influencing the LRFS and DMFS. Conclusions: The R0 resection margin and small tumor size were critical for a better prognosis.

The aim of the present manuscript was to retrospectively evaluate the efficacy of fluoroscopy-guided percutaneous vertebroplasty (PVP) for the relief of osteoblastic spinal metastases pain. PVP was performed in 39 consecutive patients with 82 osteoblastic metastatic spinal vertebras. 19 vertebras had pathologic compressive fracture and the other 63 vertebras had no compressive fracture with obvious imaging abnormalities. The ages of the patients ranged from 40 to 77 years with a mean age of 58.5±9.0 years. Visual analog scale (VAS) and QLQ-BM22 score were used to evaluate pain and quality of life at 2 days pre-operation and at 1 week and 3 months post-operation. Among all 82 vertebras, 35 vertebras had been injected bilaterally and the other 47 vertebras unilaterally. The amount of cement injected per lesion ranged from 0.5 to 4.5 ml with a mean volume of 1.6±0.8 ml. Cement deposition in all lesions was uniform. The patients were followed up from 3 to 15.5 months with a mean follow up time of 5.6±3.4 months. Mean VAS score declined significantly from preoperative 4.3±2.4 to postoperative 3.0±1.7 at 1 week and 2.4±2.0 at 3 months after the procedure (P=0.001). Mean QLQ-BM22 score declined significantly from preoperative 49.1±12.3 to postoperative 42.4±9.5 at 1 week and 39.6±10.4 at 3 months after the procedure (P<0.001). Extraosseous cement leakage occurred in 21 vertebras of 13 cases and in 1 case into the thoracic vertebra canal without causing any clinical complications. No further procedures were performed after leakage. PVP is an effective treatment for painful osteoblastic spinal metastases. It can relieve pain, reduce disability and improve function. The main complications are bone cement leakage and incomplete pain relief.

Beta-tricalcium phosphate (beta-TCP) refers to one ideal bone repair substance with good biocompatibility and osteogenicity. A digital light processing (DLP)-system used in this study creates bioceramic green part by stacking up layers of photocurable tricalcium phosphate-filled slurry with various beta-TCP weight fractions. Results show that the sintering shrinkage is anisotropic and the shrinkage vertically reaches over that horizontally. The obtained porous beta-TCP parts have both macroporous outer structure and microporous inner structure, the macropore size is 400-600 mu m and the micropore size is 500-1500 nm. The mechanical tests show that the porous beta-TCP bioceramic's compressive strength reaches 16.53 MPa. The cell culture confirmed that the porous beta-TCP bioceramic is capable of achieving the effective attaching, growing, and proliferating pertained to mouse osteoblast cells. This study identified considerable blood vessels and significant ectopic bone forming obviously based on the histologically-related assessment when implanting to rabbit femoral condyle deficiency for 3 months. Thus, under high bioactive property and osteoinductivity, and large precision and mechanical strength that can be adjusted, the DLP printed porous beta-TCP ceramics is capable of being promising for special uses of bones repairing.

Background The aim of this study was to evaluate the landscape of gene mutations and the clinical significance of tumor mutation burden (TMB) in patients with soft tissue sarcoma who underwent surgical resection and received conventional adjuvant therapy. Methods A total of 68 patients with soft tissue sarcoma were included. Postoperative tumor tissue specimens from the patients were collected for DNA extraction. Targeted next-generation sequencing of cancer-relevant genes was performed for the detection of gene mutations and the analysis of TMB. Univariate analysis between TMB status and prognosis was carried out using the Kaplan–Meier survival analysis, and multivariate analysis was adjusted by the Cox regression model. Results No specific genetic mutations associated with soft tissue sarcoma were found. The mutation frequency of TP53, PIK3C2G, NCOR1, and KRAS of the 68 patients with soft tissue sarcoma were observed in 19 cases (27.94%), 15 cases (22.06%), 14 cases (20.59%), and 14 cases (20.59%), respectively. With regard to the analysis of TMB, the overall TMB of the 68 patients with soft tissue sarcoma was relatively low (median: 2.05 per Mb (range: 0∼15.5 per Mb)). Subsequently, TMB status was divided into TMB-Low and TMB-Middle according to the median TMB. Patients with TMB-Low and TMB-Middle were 37 cases (54.41%) and 31 cases (45.59%), respectively. Overall survival analysis indicated that the median overall survival of patients with TMB-Low and TMB-Middle was not reached, and 4.5 years, respectively ( P=0.015). Conclusion This study characterizes the genetic background of patients with STS soft tissue sarcoma. The TMB was of clinical significance for patients with soft tissue sarcoma who underwent surgical resection and received conventional adjuvant therapy.

Bone metastasis is common in late-stage breast cancer patients and leads to skeletal-related events that affect the quality of life and decrease survival. Numerous miRNAs have been confirmed to be involved in metastatic breast cancer, such as the miR200 family. Our previous study identified microRNA-429 (miR-429) as a regulatory molecule in breast cancer bone metastasis. However, the effects of miR-429 and its regulatory axis in the metastatic breast cancer bone microenvironment have not been thoroughly investigated. We observed a positive correlation between miR-429 expression in clinical tissues and the bone metastasis-free interval and a negative correlation between miR-429 expression and the degree of bone metastasis. We cultured bone metastatic MDA-MB-231 cells and used conditioned medium (CM) to detect the effect of miR-429 on osteoblast and osteoclast cells in vitro. We constructed an orthotopic bone destruction model and a left ventricle implantation model to examine the effect of miR-429 on the metastatic bone environment in vivo. The transfection experiments showed that the expression levels of V-crk sarcoma virus CT10 oncogene homolog-like (CrkL) and MMP-9 were negatively regulated by miR-429. The in vitro coculture experiments showed that miR-429 promoted osteoblast differentiation and that CrkL promoted osteoclast differentiation. The two animal models showed that miR-429 diminished local bone destruction and distant bone metastasis but CrkL enhanced these effects. Furthermore, CrkL and MMP-9 expression decreased simultaneously in response to increased miR-429 expression. These findings further reveal the possible mechanism and effect of the miR-429/CrkL/MMP-9 regulatory axis in the bone microenvironment in breast cancer bone metastasis.

Melanoma was the most malignant skin neoplasm with an increasing morbidity around the world. Although new immunotherapies and targeted therapies have emerged recently, the long-term survival of melanoma patients still remains low. To reveal effective diagnostic methods and therapeutic strategies, the potential mechanism of melanoma is urgently needed to be studied. Long non-coding RNAs (lncRNAs) have become an important regulatory factor in the occurrence and development of cancer, and it can be used as a new prognostic and diagnostic marker. In this study, we aimed to inspect the effects of lncRNA colorectal neoplasia differentially expressed (CRNDE) on the melanoma cell viability, invasion and migration. After microarray analysis, 106 dysregulated lncRNAs and 1187 abnormally expressed mRNAs were screened out. Further, the lncRNA CRNDE and CCL18 expression in melanoma tissues and cell lines were examined. It was determined that they were both overexpressed in melanoma tissues and cell lines. The down-regulation of lncRNA CRNDE and CCL18 induced melanoma cell apoptosis and inhibited cell viability. Then, miR-205 which had binding site with lncRNA CRNDE and CCL18 was involved in the next experiment, and it was down-regulated in melanoma that negatively correlated with lncRNA CRNDE expression. In addition, overexpression of miR-205 results in the restore of cell viability and aggressiveness. In conclusion, LncRNA CRNDE promotes the migration and invasion of melanoma by sponging miR-205 and releasing CCL18.

A wide resection of the tumor with or without chemotherapy is the treatment of choice for periosteal osteosarcoma ( PO) of the extremities, however, post-operative limb function and quality of life could be compromised. The present study reports two cases of 14-year-old boys who presented with progressively enlarging masses in their right knee regions. Computed tomography and magnetic resonance imaging scans indicated a fusiform space-occupying mass encircling the bone cortex, with stippled calcification. A diagnosis of PO was suspected. The histological findings confirmed the diagnosis of intermediate PO. Pre-operative chemotherapies were started, and good responses were detected by clinical evaluation and histological findings. Surgeries preserving the functional structures, including neurovascular bundles, tendons, muscles and epiphyses, were performed, followed by routine chemotherapy. The two patients experienced disease-free survival with follow-up times of 37 and 108 months, respectively. The patients were satisfied with the results of the treatment and they returned to normal life activities. These two cases indicated that a marginal resection of the tumor in conjunction with effective neoadjuvant chemotherapy may be an ideal alternative treatment for intermediate PO, since survival along with well-preserved limb function could be guaranteed. By contrast, a wide excision could result in the loss of limb function.

A wide resection of the tumor with or without chemotherapy is the treatment of choice for periosteal osteosarcoma (PO) of the extremities, however, post-operative limb function and quality of life could be compromised. The present study reports two cases of 14-year-old boys who presented with progressively enlarging masses in their right knee regions. Computed tomography and magnetic resonance imaging scans indicated a fusiform space-occupying mass encircling the bone cortex, with stippled calcification. A diagnosis of PO was suspected. The histological findings confirmed the diagnosis of intermediate PO. Pre-operative chemotherapies were started, and good responses were detected by clinical evaluation and histological findings. Surgeries preserving the functional structures, including neurovascular bundles, tendons, muscles and epiphyses, were performed, followed by routine chemotherapy. The two patients experienced disease-free survival with follow-up times of 37 and 108 months, respectively. The patients were satisfied with the results of the treatment and they returned to normal life activities. These two cases indicated that a marginal resection of the tumor in conjunction with effective neoadjuvant chemotherapy may be an ideal alternative treatment for intermediate PO, since survival along with well-preserved limb function could be guaranteed. By contrast, a wide excision could result in the loss of limb function.

The outcome of limb salvage treatment for femoral osteosarcoma with pathological fractures in children is currently unknown. The aim of the present study was to present two cases of patients who received limb salvage surgery with preservation of the epiphysis at the Department of Orthopedics of The General Hospital of Jinan Military Commanding Region (Shandong, China). Between January, 2007 and January, 2013, two pediatric patients were admitted to our hospital with pathological fractures. One of the patients was a girl, aged 11 years, with confirmed osteosarcoma of the right distal femur; the other patient was a boy, aged 9 years, with osteosarcoma of the left distal femur. After receiving two cycles of neoadjuvant chemotherapy following tumor biopsy, the patients received limb salvage surgery with epiphyseal preservation, with wide resection of the tumor and biological reconstruction by allogeneic bone and fibular autograft, followed by 10 cycles of adjuvant chemotherapy. With a mean follow-up of 64 months, there were no postoperative complications, local recurrence or metastasis. The limb function recovered well, although limb shortening was observed. The female patient underwent a second fixation and limb lengthening after epiphyseal closure. Therefore, with effective neoadjuvant chemotherapy, limb salvage surgery with epiphyseal preservation is not contraindicated for pediatric patients with pathological fractures from femoral osteosarcoma. Biological reconstruction by allogeneic bone and vascularized fibular autograft following wide tumor resection is a viable option for such patients, with a good postoperative functional outcome.

ObjectiveTo study the impacts of tumor location, nature and extent of bone destruction on selection of operative protocol for extremity osteosarcoma (OS).MethodsThe medical records of 201 patients with extremity OS treated in our institute from December 1999 to June 2014 were retrospectively reviewed. Ninety eligible patients (56 males and 34 females) of average age 20 ± 11 years (range, 4–40 years) were enrolled. Tumor locations were categorized as diaphyseal (4; diaphysis group) or juxta‐articular (86); the latter being subclassified as with (51, type III, epiphysis group) or without invasion beyond the epiphyseal line or plate (35, type I and II, metaphysis group) according to MRI images. Tumor nature (osteogenic, 51; osteolytic, 39) was determined radiologically. Extent of bone destruction was quantitated according to Mirel's scoring system to obtain an “invasion score”. Regular postoperative follow‐up included physical examination and imaging evaluation.ResultsFifty‐four patients underwent biological reconstruction and 36 mechanical reconstruction. The mean follow‐up duration was 51 months (range, 6–176 months, including four deaths within 12 months). Biological reconstruction was performed more frequently in the diaphysis and metaphysis groups (31/39, 79.5%) than mechanical reconstruction (8/39, 20.5%, P < 0.05). Biological reconstruction and articular preservation were associated with more satisfactory limb function (MSTS scores: 25.0 ± 3.3 and 25.1 ± 3.6) than mechanical reconstruction and articular resection (MSTS scores: 23.4 ± 3.7 and 23.1 ± 3.4, P < 0.05). Reconstruction methods and articular preservation had no relationship with overall or tumor‐free survival (P > 0.05). Osteolytic lesions were associated with more extensive bone destruction than osteogenic lesions according to invasion scores (P < 0.05). Following biological reconstruction, high invasion scores (>8) had a 13.5‐fold risk of fracture compared with low scores (≤8) (P < 0.05). Twenty‐one subjects had recurrences, 30 metastases and 26 died. Postoperative complications included infection (6), fracture (10), and prosthesis loosening (4). Kaplan‐Meier analysis indicated 5‐ and 10‐year survival rates of 68.9% and 62.8%, respectively, and 5‐ and 10‐year tumor‐free survival rates of 66.7% and 57.8%, respectively.ConclusionSelection of limb salvage operative protocol for extremity OS should rely on tumor location, nature and extent of bone destruction. Regardless of tumor site, mechanical reconstruction is indicated for tumors with high invasion scores (>8), whereas biological reconstruction is preferred for those with low invasion scores (≤8). Tumors sparing the epiphyseal line or plate are ideal candidates for articular preservation.

Major wound complications of the extremities, following wide tumor resection and reconstruction for soft-tissue sarcomas (STSs), remain a challenge for limb-sparing surgery. Furthermore, STSs with ulceration or impending ulceration predispose patients to an increased risk of post-operative infection. The present study was conducted to assess the efficacy of negative pressure wound therapy (NPWT) in preventing wound complications associated with surgical treatment of STSs with ulceration or impending ulceration, in patients treated between February 2012 and January 2013. A total of 5 patients, with a mean age of 48 years (range, 24-68 years), were enrolled in the present study. The diagnoses consisted of undifferentiated pleomorphic sarcoma (n=2), leiomyosarcoma (n=1), synovial sarcoma (n=1) and epithelioid sarcoma (n=1). According to American Joint Committee on Cancer criteria, 3 cases were stage III tumors, and the remaining 2 cases were of stages IIA and IIB, respectively. A total of 3 patients exhibited ulceration at diagnosis, and the remaining patients demonstrated impending ulceration. The mean wound area following wide resection of the tumor was 73 cm2 (range, 45-110 cm2). A continuous suction mode, with pressures measuring -200 to -300 mmHg, was used for 7-10 days on the soft-tissue defects as preparation for wound closure. Soft-tissue reconstruction included muscle flaps (n=2) and skin grafts (n=5). No major wound complications occurred. Post-operative functional and cosmetic outcomes were acceptable. A single patient demonstrated local recurrence 12 months after surgery and re-excision of the tumor was performed. All patients remained alive at the conclusion of follow-up, with a mean follow-up time of 26 months (range, 12-36 months). The present study demonstrated that NPWT is effective and safe when used as an adjunct to wound closure following resection of extremity STS with ulceration/impending ulceration.