Limb-Sparing Surgery with Reinnervated FreeMuscle Transfer following Radical Excision of Soft-Tissue Sarcoma in the Extremity

Abstract

Limb-sparing surgery is the preferred approach in the management of patients with high-grade soft-tissue sarcomas when local disease can be completely resected. However, conventional treatment focuses only on restoration of basic functions to the remnant limb. Lost functions are not restored to normal, leaving the patient with variable degrees of functional disabilities. This in turn may necessitate further massive reconstructive procedures. Transferred reinnervated free muscles were used to reconstruct functions lost after radical resection of malignant soft-tissue sarcoma of the extremities in 17 patients. The long-term functional outcome included survival of transplanted muscle, speed of neural recovery, and muscle strength and disabilities. All muscles survived. Postoperative follow-up ranged from 27 to 106 months. All muscles except those in a 75-year-old patient were successfully reinnervated. Powerful strength and almost normal limb functions were obtained. Functional scoring of the patients according to the rating system of the Musculoskeletal Tumor Society was 87 percent for the lower extremity and 93 percent for the upper extremity. All patients are presently disease-free. Use of the reinnervated free-muscle transfer in limb-sparing surgery after resection of soft-tissue sarcoma in the extremity may be indicated in the young adult when radical excision of the tumor will result in severe motor functional loss, provided adequate clearance can be obtained and that there is no presence of distant metastasis.

Quadriceps muscle reconstruction with free functioning latissimus dorsi muscle flap after oncological resection

“…14 The transfer of latissimus dorsi is best indicated in cases in which at least one head of the four heads of the quadriceps muscle could be spared. 29 In this study; patients in which three heads of the muscle had been resected, had considerable improvement of the function in correlation to the progressing reinnervation of the transferred muscle.…”

“…The free functioning muscle transfers have many indications in both upper limb 12 and in craniofacial 13 reconstructive surgeries, although it is rarely used for the lower limb motor reconstruction. 14 Total or partial reconstruction of the quadriceps after soft tissue's sarcomas excision with free functioning latissimus dorsi muscle transfer has become more popular in the last years because of the relative efficacy of the technique in reducing functional deficits after the loss of the extensor compartment of the thigh.…”

Free functional rectus femoris muscle transfer for restoration of extension of the foot after lower leg compartment syndrome

“…12 To avoid a decrease in leg strength and knee extension, the intraoperative linking of the vastus lateralis muscle with the vastus medialis muscle, especially in their lower third, and an extensive postoperative rehabilitation and training program are important. Doi et al 13,14 reported on two reinnervated free gracilis muscle transfers following radical excision of soft-tissue sarcoma in the lower leg. All extensor muscles of the ankle and toes were resected, and their gracilis muscles were transferred.…”

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

“…The motor nerve of the gracilis was sutured to the motor branch of the tibialis anterior muscle from the peroneal nerve, resulting in gradual increase in power and range of toe and ankle extension postoperatively. In a second series by Doi et al [42] , reinnervated latissimus dorsi transfer was used to improve or supplement knee flexion or extension by connecting to the sciatic or femoral nerve at the time of reconstruction.…”