Microvascular reconstruction after resection of soft tissue sarcoma of the leg

Barner-Rasmussen, Ian; Popov, Pentscho; Böhling, Tom; Tarkkanen, Maija; Sampo, Mika; Tukiainen, Erkki

doi:10.1002/bjs.6581

Cited by 29 publications

(36 citation statements)

References 26 publications

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“…Some experts have advocated for early tissue coverage (3,6,14,(18)(19)(20)(21)(22)(23)(24)(25); yet, others have shown success through approaching extremity injuries conventionally with serial débridements and secondary reconstruction in a delayed manner (26)(27)(28)(29)(30)(31).…”

Section: Introductionmentioning

confidence: 99%

Free tissue transfer to the traumatized upper extremity: Risk factors for postoperative complications in 282 cases

Gupta

Lakhiani

Lim

et al. 2015

Journal of Plastic, Reconstructive & Aesthetic Surgery

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Section: Introductionmentioning

confidence: 99%

Free tissue transfer to the traumatized upper extremity: Risk factors for postoperative complications in 282 cases

Gupta

Lakhiani

Lim

et al. 2015

Journal of Plastic, Reconstructive & Aesthetic Surgery

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“…As a solution, several authors describe the ALT flap as a preferred method for distal lower extremity defects following sarcoma resection, given the easy ability to reshape the flap [11,22] . In a series by Barner-Rasmussen et al [9] , 73 patients with soft tissue tumors located predominantly in the distal leg received 75 free-flap procedures with a 95% flap survival rate and a 97% limb salvage rate. A majority of the flaps used were latissimus dorsi flaps (72%) and ALT flaps (12%).…”

Section: Below Kneementioning

confidence: 99%

“…The rectus abdominis and latissimus dorsi flaps as well as free scapula flaps have been described for this region by Cordeiro et al [6] with an overall success rate close to 90%. Other flaps commonly used in the lower leg are the radial forearm flap, gracilis flap, tensor fascia lata flap, and fibula flap [9] .…”

Section: Below Kneementioning

confidence: 99%

“…To this end both pedicled and free tissue transfers have become a central component of lower extremity salvage after resection and chemo-radiation therapy. Recent data has shown that these complex reconstructions have provided faster recovery with adequate soft tissue reconstruction and maintenance of functionality of the limb [2,[6][7][8][9][10][11] .…”

Section: Introductionmentioning

confidence: 99%

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

Azadgoli¹,

Carre²,

Perrault³

et al. 2018

PAR

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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.

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“…[34] Limb salvage with microvascular reconstruction is safe and reliable in lower extremity STS reconstruction, which has avoided amputation in most patients. [4041]…”

Section: Soft-tissue Sarcomamentioning

confidence: 99%

Limb salvage surgery

Kadam¹

2013

Indian J Plast Surg

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The threat of lower limb loss is seen commonly in severe crush injury, cancer ablation, diabetes, peripheral vascular disease and neuropathy. The primary goal of limb salvage is to restore and maintain stability and ambulation. Reconstructive strategies differ in each condition such as: Meticulous debridement and early coverage in trauma, replacing lost functional units in cancer ablation, improving vascularity in ischaemic leg and providing stable walking surface for trophic ulcer. The decision to salvage the critically injured limb is multifactorial and should be individualised along with laid down definitive indications. Early cover remains the standard of care, delayed wound coverage not necessarily affect the final outcome. Limb salvage is more cost-effective than amputations in a long run. Limb salvage is the choice of procedure over amputation in 95% of limb sarcoma without affecting the survival. Compound flaps with different tissue components, skeletal reconstruction; tendon transfer/reconstruction helps to restore function. Adjuvant radiation alters tissue characters and calls for modification in reconstructive plan. Neuropathic ulcers are wide and deep often complicated by osteomyelitis. Free flap reconstruction aids in faster healing and provides superior surface for offloading. Diabetic wounds are primarily due to neuropathy and leads to six-fold increase in ulcerations. Control of infections, aggressive debridement and vascular cover are the mainstay of management. Endovascular procedures are gaining importance and have reduced extent of surgery and increased amputation free survival period. Though the standard approach remains utilising best option in the reconstruction ladder, the recent trend shows running down the ladder of reconstruction with newer reliable local flaps and negative wound pressure therapy.

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Microvascular reconstruction after resection of soft tissue sarcoma of the leg

Abstract: Without microvascular reconstruction, amputation would have been necessary in most patients. Microvascular reconstruction is safe and reliable in lower extremity STS reconstruction.

Cited by 29 publications

References 26 publications

Free tissue transfer to the traumatized upper extremity: Risk factors for postoperative complications in 282 cases

Free tissue transfer to the traumatized upper extremity: Risk factors for postoperative complications in 282 cases

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

Limb salvage surgery

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