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

Abstract

This method of reconstruction is a reliable technique not only to fill the defect resulting from oncological resection but also to provide better function. Microsurgical reconstruction of soft tissue sarcoma helps to expand the indications of limb salvage by allowing better local control and achieving adequate function and coverage.

Local tendon transfer for knee extensor mechanism reconstruction after soft tissue sarcoma resection

“…Thereby, patients reached an average muscle manual test (MMT) score of 3 out of 5 and were capable of walking and stair climbing without support after an average follow-up of 69 months. 30 Muramatsu et al revealed even better results in 14 patients undergoing the same reconstructive procedure with an average MMT score of 4.8 after 79 months. 31 In a case series of Wechselberger et al 2 patients received free rectus femoris neurovascular muscle grafts for reconstruction of the opposite thigh extensors.…”

A reappraisal of functional reconstruction of extension of the knee following quadriceps resection or loss

“…Certain caveats exist regarding the use of free muscle transfers. First, given the prolonged duration of recovery of function, the use of this procedure should be carefully considered in patients with metastatic disease (23% of patients in one study 38 ). Although quality of life may be enhanced by functional reconstruction, other options, such as pedicled muscle transfer, should be considered.…”

“…In cases in which the femoral periosteum has been removed, a proximally based portion of vascularised fascia lata can be inserted between bone and the transferred muscle to permit a gliding plane. 38 The muscle flap may be inserted with the proximal pole sutured to the tendon of rectus femoris proximally, or with bone anchors to the femur 37 (Figs 4 and 5).…”

“…Innocenti et al 38 reported good functional results in a series of 11 patients with a sarcoma who underwent reconstruction following partial or total quadriceps resection using free functioning latissimus dorsi. Early contractile activity of the muscle was regained at a mean of 8.3 months, with an increase in strength plateauing at two years.…”

“…Secondly, confounding exists in many studies through the use of combined methods of reconstruction, such as the simultaneous use of pedicled muscle and free flap transfers. 38 Thirdly, the aetiology of extensor mechanism loss has an important influence on functional outcomes. Patients with tumour, poliomyelitis and ruptures after TKR present with differing baseline characteristics.…”