Segmental Resection and Replantation for Primary Malignant or Aggressive Tumors of the Upper Limb

For malignant tumors of the upper limb, limb-salvaging procedures are now well-established. However, in cases of stage IIB tumors, amputation would be the treatment of choice for oncological reasons. Segmental resection-replantation is a valuable alternative to amputation as partial limb salvage in these cases. The purpose of this study was to evaluate functional outcome and complications after segmental resection-replantation for the treatment of large primary malignant tumors of the upper limb.

The authors reviewed the results of 10 patients with large primary malignant tumor or aggressive benign tumor of the upper limb, who underwent segmental resection-replantation, between 1986 and 2000. Seven men and 3 women were operated on at a mean age of 30.6 years (15 to 46 years); the average follow-up was 103 months (52 to 137 months). Primary indications for this method were stage IIB tumors for which only amputation can achieve wide resection because of the extent. There were three chondrosarcomas, two osteosarcomas, two giant cell tumors with pathologic fracture, one extensive chondroblastoma, one Ewing's sarcoma, and one leiomyosarcoma.

Wide resection margins were achieved in all ten cases. One patient died at 40 months after surgery due to systemic metastasis. Nine patients have remained disease-free without local recurrence or metastasis. The average over-all functional rating was 65% (43~90%) for ten patients at last follow-up by the criteria of the Musculoskeletal Tumor Society functional evaluation system. The mean grasping power and the mean pinching power of at the operated side hand were 75% (28~95%) and 82% (43~90%) of the opposite hand, respectively. There were 4 complications in total. Three wound dehiscences were treated with secondary procedures, and the other case with radial nerve palsy spontaneously recovered.

Considering the functional and oncological results after segmental resection-replantation, this technique might be very useful for partial limb salvage in selected cases for the treatment of malignant tumors of the upper limb which, due to their extent, are often amenable only to amputation for achieving wide resection.