Efficacy of Ultrasonic Scalpel in Orthopaedic Oncology Surgery: An Initial Patient Cohort Study Based on Propensity Score Matching Analysis.

Abstract

Ultrasonic scalpels (USs) have been widely used in various cancer surgeries due to their advantages of minimal thermal damage, effective vascular/lymphatic sealing, and reduced complications. However, robust evidence supporting their efficacy in soft-tissue sarcoma (STS) surgery remains limited, especially for large-size thigh STS (≥8 cm)-a subgroup characterized by high intraoperative bleeding risk and frequent wound healing issues. This study aimed to comprehensively evaluate the efficacy of USs in the surgical management of large thigh STS (≥8 cm). We conducted a retrospective study of patients who underwent surgical resection of large thigh STS (≥8 cm) between January 2019 and December 2024. Patients' clinical characteristics and treatment details were meticulously collected, and key metrics analyzed included intraoperative blood loss, hospital stays, and wound complications. To reduce selection biases, propensity score matching was applied. We defined the matched cases wherein US was used as the "using group" and the other matched cases as the "non-using group." Outcomes were compared between the groups. After propensity score matching, 36 patients were included in each group. The ultrasonic using group showed markedly reduced estimated intraoperative blood loss (204.2 vs. 505.6 mL; P = 0.041) and shorter hospital stay (6.9 vs. 11.4 days; P = 0.002). In addition, the incidence of major wound complications (Clavien-Dindo grade III or higher) was markedly lower (13.9% vs. 38.9%; P = 0.031). Multivariate logistic regression analysis confirmed that US use was independently associated with fewer major wound complications (odds ratio, 0.118; 95% confidence interval, 0.026 to 0.531; P = 0.005). The application of USs in the surgical resection of large thigh STS (≥8 cm) is associated with reduced intraoperative blood loss, shorter hospital stay, and lower rates of major postoperative wound complications. These findings support the potential value of US as a technical adjunct in complex STS surgery and warrant further validation in prospective randomized controlled trials.