Complex reconstruction of the lower extremity following sarcoma resection: a literature review

Abstract

While amputation was traditionally the only option available for patients with sarcomas of the extremities, chemotherapy, radiation, and advances in microsurgical technique have allowed many patients to undergo limb-salvaging procedures. Given the low incidence and heterogeneity of these tumors, there is currently no standard treatment algorithm for limb reconstruction after large sarcoma resection. Thus, we systematically reviewed the various types of free tissue transfer used for the reconstruction of lower limbs after sarcoma resection. Techniques were described based on anatomic location. This literature review supports free tissue transfer as a safe and acceptable modality for reconstruction after sarcoma resection of the lower limb. It allows for the application of healthy vascularized tissue to the defect while also providing freedom of flap positioning. Flap choice is dependent on tumor and defect size, tissue type and function, as well as donor site availability.

Prediction of soft tissue coverage following distal femur bone sarcoma resection: A preliminary report

“…19 Free tissue transplantation may be required in patients with a large amounts of soft tissue defects. 20 In our study, none of the patients developed flap loss or morbidity at the donor site. We identified superficial wound problems at the rate of 14.3% (n = 6) during postoperative followups.…”

Brazilian consensus on the diagnosis and treatment of extremities soft tissue sarcomas

“… Repairs with pedicled muscle or fasciocutaneous flaps vascularized free flaps, and vascular or nerve grafts should be used as needed. Pediculated flaps have traditionally been preferred for oncological resections, but their use can be disregarded when using neoadjuvant RT 51 (IVB). Free tissue transfer allows the application of healthy vascularized tissue to the defect while providing the freedom to position the flap and avoiding elongation or elbowing of the vessels 52 . This reconstructive strategy is recommended for large areas that have undergone RT or when deemed necessary (IVB). The flap for bone reconstruction is chosen, based on the location of the lesion, the level of activity of the individual, the need for adjuvant therapy, and growth potential.…”

“…The 2‐ and 5‐year overall survivals are 61.6% and 30.0%, respectively 54 Reconstruction of motor nerves should be considered when limb preservation surgery is indicated, wherein an important motor nerve (IVB) will be killed. When vascular resection is necessary to obtain adequate margins after conservative limb surgery, arterial reconstruction is always the most important procedure to prevent ischemia, whereas the need for venous reconstruction is not well‐established 51 (IVB).…”

“…Repairs with pedicled muscle or fasciocutaneous flaps vascularized free flaps, and vascular or nerve grafts should be used as needed. Pediculated flaps have traditionally been preferred for oncological resections, but their use can be disregarded when using neoadjuvant RT 51 (IVB).…”

“…When vascular resection is necessary to obtain adequate margins after conservative limb surgery, arterial reconstruction is always the most important procedure to prevent ischemia, whereas the need for venous reconstruction is not well‐established 51 (IVB).…”