Limb‐sparing sarcoma reconstruction with functional composite thigh flaps

Stranix, John T.; Lee, Z‐Hye; Lam, Gretl; Mirrer, Joshua; Rapp, Timothy; Saadeh, Pierre B.

doi:10.1002/micr.30254

Cited by 13 publications

(10 citation statements)

References 19 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…As fasciocutaneous reconstructive techniques for lower limb sarcomas continue to develop,11 the MSSAP flap provides an alternative to free flap reconstructions in the distal third of posterior thigh. However, anatomical variants mean that this option is not always available as in 8% the median superficial sural artery is absent,12 and in some ways can be regarded as an opportunistic technique which can make dissection of the case significantly easier as there is little to no muscle dissection required.…”

Section: Discussionmentioning

confidence: 99%

Split median superficial sural artery perforator (MSSAP) flap and medial sural artery perforator (MSAP) flap for posterior thigh sarcoma reconstruction

Mazur

Osinga

2020

BMJ Case Rep

View full text Add to dashboard Cite

Reconstruction of composite defects of the posterior thigh and knee is challenging. Pedicled medial gastrocnemius flaps are the traditional reconstructive approach, but late contractures related to skin grafted muscle may affect knee function. More recently, the medial sural artery perforator (MSAP) flap has been described for such defects, although may necessitate skin grafting of the donor site. To minimise the drawbacks with these options, we describe a combination of a median superficial sural artery perforator (MSSAP) flap and MSAP flap. This allows both tension free closure of the donor site without skin grafting, and facilitates coverage of a round defect by splitting the flap into two adjacent triangular flaps. This is the first report of posterior thigh defect reconstruction with a combination of MSSAP and MSAP flaps.

show abstract

Section: Discussionmentioning

confidence: 99%

Split median superficial sural artery perforator (MSSAP) flap and medial sural artery perforator (MSAP) flap for posterior thigh sarcoma reconstruction

Mazur

Osinga

2020

BMJ Case Rep

View full text Add to dashboard Cite

show abstract

“…The included articles were published from 1993 to 2021 and were categorized as level 4 or 5 according to the Oxford Centre for Evidence-Based Medicine (OCEBM). [4][5][6][7][8][9][10][11][12][13][14][15][24][25][26][27][28][29][30][31][32][33][34][35][36][37][38][39][40][41][42][43]…”

Section: Eligibility Criteria and Study Selectionmentioning

confidence: 99%

“…FMT can be harvested with the muscle's neurovascular pedicle for a distant transfer or islandized on its neurovascular pedicle and rotated. The latissimus dorsi (LD), [4][5][6][7] gracilis, [8][9][10] tensor fasciae lata (TFL), 5,7,8,11 and vastus lateralis [12][13][14][15] are the most commonly used donor muscles for FMT. Aside from restoring motor function to the involved extremity, FMT with vascularized, nonirradiated tissue provides…”

Section: Introductionmentioning

confidence: 99%

Functional Muscle Transfer after Oncologic Extremity Resection

Hassan

Tesfaye

Rashiwala

et al. 2022

J Reconstr Microsurg

View full text Add to dashboard Cite

Background: Functional muscle transfer (FMT) can provide wound closure and restore adequate muscle function for patients with oncologic extremity defects. Herein we describe our institutional experience with FMT after oncological resection and provide a systematic review and meta-analysis of the available literature on this uncommon procedure. Methods: A single-institution retrospective review was performed, including all patients who received FMT after oncological resection from 2005-2021. For the systematic review and meta-analysis, PubMed, Cochrane, Medline, and Embase libraries were queried according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines; results were pooled, weighted by study size, and analyzed. Results: The meta-analysis consisted of seven studies with 70 patients overall, demonstrating a mean MRC score of 3.78 (95% CI, 2.97-4.56; p < 0.01). The systematic review included 28 studies with 103 patients. Receipt of adjuvant chemotherapy was associated with significantly lower mean MRC score (3.00 ± 1.35 vs. 3.90 ± 1.36; p = 0.019). Seventy-four percent of the patients underwent free FMT, with the most common donor muscle being the latissimus dorsi (55%). The flap loss rate was 0.8%. Neoadjuvant chemotherapy (p = 0.03), radiotherapy (p = 0.05), pedicled FMTs (p = 0.01), and a recipient femoral nerve (p = 0.02) were associated with significantly higher complication rates. The institutional retrospective review identified 13 patients who underwent FMT after oncological resection with a median follow-up time of 21 months (range, 6-74 months). The most common tumor necessitating FMT was undifferentiated pleomorphic sarcoma (77%), and the most common donor muscle was the latissimus dorsi (62%). A high body mass index was associated with prolonged neuromuscular recovery (R = 0.87, p = 0.002). Conclusion: FMT after oncological resection may contribute to improved extremity function. Careful consideration of risk factors and preoperative planning is imperative for successful FMT outcomes.

show abstract

“…The lateral femoral cutaneous nerve can be included for possible sensory reinnervation. 21 LD muscle or myocutaneous free flap is a valuable option for functional reconstruction after extensor or flexor compartments resection. 16 , 40…”

Section: Forearm and Wristmentioning

confidence: 99%

Reconstruction of upper limb soft-tissue defects after sarcoma resection with free flaps: A systematic review

Lucattelli

Lusetti

Cipriani

et al. 2021

Journal of Plastic, Reconstructive & Aesthetic Surgery

View full text Add to dashboard Cite

Background and Objectives: Upper limb preservation after soft tissue sarcoma (STS) surgical excision is now the accepted gold standard and it often requires reconstruction with free flaps. The purpose of this review is to summarize current literature on upper limb reconstruction with free flaps after STS resection. Methods: A systematic review was performed in July 2019 in PubMed and MedLine Ovid databases according to the PRISMA guidelines. Results: A total of 17 studies were included in the final analysis, with 132 patients. The most common diagnosis was Malignant Fibrous Histiocytoma. The most frequent timing of flap coverage was immediate. The success rate was almost always 100%. The length of follow-up was reported in 11 studies with a range of 2-187 months. The most commonly reported patientcentered outcome was the MSTS Score. Based on the evidence of the literature collected, we divided the upper limb into four parts (shoulder, elbow and arm, forearm and wrist, and hand) and described the most common and functional free flaps used for reconstruction after STS resection. Conclusions: Free flaps in the treatment of STS of the upper extremity have a good overall outcome, with a low postoperative complication rate. A wide array of free flaps is available for reconstruction, and the choice of flap is based on defect size, types of tissue required, postoperative functional goal, and surgeon preference. A greater degree of standardization is needed in the reporting of patient-centered outcomes to facilitate future comparative studies.

show abstract

Limb‐sparing sarcoma reconstruction with functional composite thigh flaps

Abstract: Limb-sparing techniques for upper and lower extremity sarcomas continue to evolve. Our experience has validated the composite thigh free flap as an excellent option for one-stage functional reconstruction of large limb defects.

Cited by 13 publications

References 19 publications

Split median superficial sural artery perforator (MSSAP) flap and medial sural artery perforator (MSAP) flap for posterior thigh sarcoma reconstruction

Split median superficial sural artery perforator (MSSAP) flap and medial sural artery perforator (MSAP) flap for posterior thigh sarcoma reconstruction

Functional Muscle Transfer after Oncologic Extremity Resection

Reconstruction of upper limb soft-tissue defects after sarcoma resection with free flaps: A systematic review

Contact Info

Product

Resources

About