Superficial Tumor Location and Adiposity as Independent Predictors of Postoperative Wound Complications in Sarcoma Resections of the Thigh

INTRODUCTION: Soft tissue sarcoma (STS) resections of the thigh have high rates of wound complications, but the effect of tumor depth and surrounding tissue composition on wound risk is not fully understood. We aimed to determine whether skin-to-tumor distance and regional thigh adiposity independently predict postoperative wound complications. METHODS: We retrospectively reviewed 125 patients who underwent thigh STS resection from 2013 to 2025. Preoperative MRI or CT was used to measure (1) the shortest skin-to-tumor distance in the quadrant with the greatest tumor burden and (2) average thigh adiposity across the remaining quadrants. The primary endpoint was a composite of wound dehiscence, infection, or return to the operating room within 90 days. Multivariable logistic regression was used, adjusting for demographic, treatment, and tumor variables. RESULTS: Composite wound complications occurred in 34 patients (27%). Each 1-cm increase in skin-to-tumor distance reduced the odds of complication by approximately 80% (OR = 0.21, 95%-CI: 0.07-0.61, p = 0.004), while each 1-cm increase in average thigh adiposity nearly doubled the risk (OR = 1.92, 95%-CI: 1.08-3.41, p = 0.025). Findings were consistent for wound dehiscence, with similar trends observed for infection. CONCLUSION: Both superficial tumor location and increased thigh adiposity independently predict postoperative wound complications. Incorporating radiographic measures of local coverage and regional tissue quality may enhance preoperative risk assessment and assist in reconstructive planning for extremity soft tissue sarcoma surgery.