Utilization of Modified Rhomboid Flap to Reconstruct Limb Defect after Wide Resection of Large Soft-tissue Sarcoma: Novel Application of an Old Technique

Abstract

Background: Reconstruction of limb defects following wide resection of large soft-tissue sarcomas (STS) is challenging. Effectiveness of rhomboid flaps in covering these wounds remains to be addressed. Methods: From March 2018 through February 2019, we utilized modified rhomboid flaps to reconstruct limb defects following wide resection of the large STS (≥5 cm in diameter) in 6 patients. There were 3 males and 3 females. The average age was 65 years (47-77 years). Diagnoses included leiomyosarcoma in 3 patients, synovial sarcoma, undifferentiated pleomorphic sarcoma, and myxoid liposarcoma in 1 respectively. The anatomic locations included the anterior knee in 3 cases, upper arm in 2, and thigh in 1. The mean diameter of the tumor measured 10 cm (5-17 cm). The mean defect size was 113 cm2(38-270 cm2). Results: The mean follow-up duration was 10 months (range, 6-12 months), no patients were lost to follow-up. Skin grafts were utilized in 2 cases. The mean time to heal was 7 weeks (range, 3-13 weeks). At final follow-up, there were no recurrence and metastasis. One case had cerebral hemorrhage and 1 had wound dehiscence, whereas no reoperation was performed. The range of motion of the joints adjacent to the flap reconstructions were comparable to preoperative status. The mean Musculoskeletal Tumor Society score was 27 (range, 24-30). Conclusions: The modified rhomboid flap affords great versatility and is easy to design. This technique yields satisfactory effectiveness in reconstructing limb defects after resection of large STS. Long-term studies of large sample size are warranted.