The rationale for planned reoperation after unplanned total excision of soft-tissue XXXX .

@entity1 @entity632 @entity66 @entity242 @entity41 @entity5 @entity75
Multimodality management of soft-tissue @entity242 of the extremity is often based on the presence or absence of residual primary disease. Reoperation is warranted or radiotherapy doses altered if the physician is aware that the @entity5 was incompletely excised. Most @entity1 with soft-tissue masses undergo an initial excision before definitive therapy. These initial unplanned total excisions are usually excisional biopsies for presumably benign disease. Ninety @entity1 were reviewed to evaluate the adequacy of unplanned total excision. All @entity1 underwent unplanned supposed total excisions. Most @entity1 were then treated with preoperative intraarterial @entity632 (Adria Laboratories, Columbus, Ohio) and radiation therapy, followed by wide reexcision of the prior operative field. Forty-six @entity1 (51.1%) had no gross @entity41 in the reoperative specimen. In two @entity1 , there was microscopic but not macroscopic disease. Forty-four @entity1 (48.9%) had identifiable macroscopic @entity66 in the reoperative specimen. When comparing these 44 @entity1 with visible (macroscopic) @entity41 to the remaining 46, no differences were seen in age, sex, stage, histologic type, time from excision to reoperation, or size of @entity75 . This previously unrecognized high incidence of gross @entity66 must be considered when planning definitive therapy. Unplanned total excisions are inadequate to remove @entity66 and, despite multimodality therapy, may result in local failure. Reoperation should be a planned part of definitive management for @entity1 with soft-tissue @entity242 of the extremity whenever the initial surgical procedure was done without a histologic diagnosis or was not planned to be a wide excision. If reoperation cannot be performed, radiotherapy doses to treat gross @entity66 should be used.
