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New Classification System Links Wound Complications to Cancer Treatment Delays in Pediatric Bone Sarcomas

New Classification System Links Wound Complications to Cancer Treatment Delays in Pediatric Bone Sarcomas 150 150 Pam Georgiana

Study identifies patients at highest risk and provides a framework for earlier multidisciplinary intervention.

Children with osteosarcoma and Ewing sarcoma, the two most common pediatric bone sarcomas, typically start treatment before tumor resection, then promptly resume chemotherapy or their clinical trial protocol after surgery. Because these patients are often immunosuppressed, postoperative wound complications can delay treatment and affect long-term outcomes.

A new study from Nationwide Children’s Hospital, published in the Journal of Pediatric Surgery, found that postoperative wound complications occurred in 43% of children undergoing extremity bone sarcoma surgery. The investigators also developed the first wound classification system designed specifically to measure the impact of postoperative wound complications on oncologic care.

“Surgeons have always known wound complications occur in these patients, but we never had a way to quantify how often they happen or, more importantly, how they affect cancer treatment,” says Thomas J. Scharschmidt, MD, director of the Pediatric Orthopedic Oncology Program at Nationwide Children’s and professor in Orthopaedics at The Ohio State University College of Medicine. “Our goal was to close that gap by developing a classification system that helps surgeons identify high-risk patients and intervene earlier.”

The retrospective study examined 88 children treated for extremity osteosarcoma or Ewing sarcoma over 16 years at Nationwide Children’s. More than half of the 38 patients with wound complications had Grade III complications, the most severe category. Grade III complications involve delays in chemotherapy, changes in oncologic treatment or the need for additional surgery.

The median time to developing wound complications was about 30 days after surgery. This coincides with the critical period when most patients prepare to resume chemotherapy.

“That timing is particularly concerning because we know delays beyond six weeks in restarting chemotherapy can adversely affect survival,” Dr. Scharschmidt explains. “If we can identify patients at highest risk and intervene earlier, we may be able to keep more children on their intended treatment schedule.”

One of the first and largest studies of its kind, the research also identified patients at greatest risk. Children with tumors involving the tibia or fibula had the highest rates of wound complications, likely because the lower leg has limited soft tissue coverage, making reconstruction more challenging. Patients needing both orthopedic tumor resection and plastic surgery reconstruction also had higher complication rates. These cases usually involve larger, more complex tumors requiring extensive reconstruction.

Jenny C. Barker, MD, PhD, principal investigator in the Center for Regenerative Medicine and director of the Comprehensive Wound Care Center at Nationwide Children’s, says the findings demonstrate the significance of multidisciplinary planning for high-risk patients.

“We know children receiving extensive limb reconstruction face unique challenges with wound healing,” Dr. Barker says. “These data help us identify patients who may benefit from early collaboration between orthopedic oncology, reconstructive surgery and wound care specialists so we can proactively manage risk rather than respond after complications develop.”

Unlike existing wound grading systems, which primarily describe wound characteristics or the interventions required, the new classification framework measures the impact of wound complications on cancer treatment. The investigators believe it could standardize reporting across institutions, improve comparisons among studies and support future clinical trials evaluating strategies to reduce treatment delays.

While the current study focused on osteosarcoma and Ewing sarcoma, Dr. Scharschmidt also believes the new classification system may have broader applications.

“This is a first step toward understanding a problem that has never been systematically measured,” Dr. Scharschmidt says. “It’s too early to know whether these data will apply across other pediatric cancers, but the long-term goal is to better understand how wound complications affect oncologic care so we can improve care for all children with cancer.”

The researchers plan to validate the classification system through the Children’s Oncology Group and implement new proactive multidisciplinary approaches at Nationwide Children’s to enhance wound healing and help patients stay on schedule with their cancer therapy.

Reference:

Qureshi AA, Kennedy CC, Gupta R, Schroeder MJ, Nieveras M, Lin S H-Y, Bjorklund KA, Scharschmidt T, Barker JC. Incidence, predictive factors, and proposed classification of wound complications in pediatric extremity bone sarcoma patients following extirpative surgery. Journal of Pediatric Surgery. Published online April 25, 2026. doi:10.1016/j.jpedsurg.2026.163134

About the author

Pam Georgiana is a brand marketing professional and writer located in Bexley, Ohio. She believes that words bind us together as humans and that the best stories remind us of our humanity. She specialized in telling engaging stories for healthcare, B2B services, and nonprofits using classic storytelling techniques. Pam has earned an MBA in Marketing from Capital University in Columbus, Ohio.

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