Primary flap reconstruction of tissue defects after sarcoma surgery enables curative treatment with acceptable functional results: a 7-year review

Abstract

BackgroundSarcomas, a heterogeneous group of tumors, are challenging to treat and require multidisciplinary cooperation and planning. We analyzed the efficacy of flap reconstruction in patients with bone and soft tissue sarcoma.MethodsPatient charts and operative records were retrospectively reviewed from January 2006 through October 2013 to identify sarcoma patient characteristics, postoperative complications, revisions, recurrences, and survival. Pedicled and/or free flap reconstruction was performed in 109 patients. Flap selection was based on defect size, and exposure of anatomically critical structures or major orthopedic implants.ResultsOf 109 patients, 71 (65.1 %) were men, and mean age was 56.4 years. Tumors most frequently located in a lower extremity (38.7 %). Primary sarcomas comprised 79.2 % and recurrences occurred in 18.9 %. Wide resection was performed for 65.7 %, and there were 10 planned amputations combined with flap reconstruction. A total of 111 tumors received 128 flaps: 76 pedicled flaps, 42 free flaps, and 5 combined (10 total) pedicled + free-flaps. The success rate was 94 % for the pedicled flap group, 97 % for the free-flap group, and 100 % for the pedicle + free-flap group. Of 35 patients, 5 developed deep prosthetic infections. Only one amputation due to disease progression was performed. Satisfactory functional outcome was achieved in 69 %. Survival rate during a mean (standard deviation) 3(2) year follow-up was 83.5 %.ConclusionsPrimary flap reconstruction after sarcoma surgery satisfies oncologic goals. Large tumors in difficult areas can be removed and complete tumor resection achieved. Our findings indicate a high survival rate after sarcoma surgery utilizing flap reconstruction and a low recurrence rate.

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

“…Lopez et al [2] found that patients who received combined pedicled + free flaps after sarcoma resection had significantly higher wound complications rates compared to patients who received just one, although systemic complications were distributed equally between all groups.…”

“…[65] 2011 Outcomes Lopez et al . [2] 2015 Outcomes Table 2. Types of flaps used for lower extremity reconstruction based on region Author Year Regions described Flaps described Cordeiro et al .…”

“…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] .…”

“…Soft tissue and bone sarcomas represent about 1% of all adult tumors [1] , affecting 1.8-5 out of every 100,000 people annually [2] . The lower limb is the most common site of sarcoma occurrence, representing 29%-40% of all cases [3,4] .…”

“…Although amputation was traditionally the only option available for patients with sarcoma of the extremities, recent implementation of a multimodal treatment approach along with advancements in chemotherapy and microsurgical techniques has led to the influx of limb salvage therapy for these cancers [5,6] . Currently, wide tumor excision combined with adjuvant and or neo-adjuvant therapy is the standard of care for the successful treatment of sarcoma of the lower limbs [2] . Quite often, sarcoma excision results in large anatomical soft tissue deficits with resultant exposure of vital structures such as bones, tendons, and neurovascular bundles, necessitating complex soft tissue reconstruction with vascularized soft tissue transfer thus facilitating further treatments as well as maintaining or regaining structural function and integrity of the limb in question.…”