Abstract
Background
The treatment approach for soft tissue sarcomas (STS) of the lower extremity has shifted
toward the use of neoadjuvant radiation combined with limb-sparing surgery (LSS).
The resulting defects often require reconstruction with free tissue transfer for adequate
outcomes. Data have demonstrated a potentially increased risk of microvascular complications
for free flaps performed using irradiated recipient vessels. Similarly, certain anatomic
areas of the lower extremity have a high proportion of unnamed perforators that are
available as recipient vessels, increasing the technical difficulty. We aimed to determine
if the characteristics of recipient vessels that were used for the reconstruction
of STS defects influenced rates of microvascular complications in our patients.
Methods
A retrospective chart review of all patients who underwent reconstruction of lower
extremity STS defects with free tissue transfer from 2009 to 2020 was conducted. Data
regarding recipient vessel type (axial vessel vs. unnamed perforator), radiation status
of the recipient vessels (irradiated vs. non-irradiated), and microvascular complications
were compared across groups.
Results
A total of 204 free flaps were included. The overall microvascular complication rate
was 13.7% (28 cases). Most microvascular complications were detected postoperatively
(82.1%) rather than intraoperatively, with the majority involving venous congestion/thrombosis
(20 cases, 71.4%). While there was a trend toward increased microvascular complications
with the use of irradiated recipient vessels (27 cases, 96.4%), this did not reach
statistical significance (OR = 1.98, p = 0.52). The use of perforating branches as recipient vessels did not confer an increased
risk of microvascular complications (OR = 0.87, p = 0.75).
Conclusion
The reconstruction of irradiated lower-extremity STS defects represents a particularly
challenging issue. This analysis demonstrates that free tissue transfer can be safely
performed using irradiated vessels without a significantly increased risk of microvascular
complications. Furthermore, unnamed perforating branches can be successfully used
for reconstruction in anatomically challenging areas of the lower extremity.
Keywords sarcoma - radiation - lower extremity reconstruction - recipient vessels
