Abstract
Background Lower extremity soft tissue sarcoma treatment has evolved from primarily amputation
procedures toward limb salvage. This series assesses whether soft tissue sarcoma tissue
defects, extensive enough to require microsurgical reconstruction, can reliably result
in preservation of ambulation, as well as objectively evaluate functional outcomes
utilizing a patient-reported validated scale. It will also look at whether immediate
functional muscle reconstructions and tendon transfers can be successful at restoring
ambulation, potentially expanding the indications for limb salvage procedures.
Methods A retrospective review of all microsurgical reconstructions for limb salvage in lower
extremity sarcoma patients was completed at our institution (2009–2013). Patients
were additionally asked to complete the Toronto Extremity Salvage Score(TESS) quality
of life survey.
Results Over a 5-year period, 23 patients (mean age: 53 years) underwent free flap reconstructions
for 23 sarcomas (mean follow-up: 14 months). Seventy-eight percent of patients received
neoadjuvant radiation. The thigh was the most common tumor site (61%) and three muscles
were resected on average. Perforator flaps were most frequently used (61%), and functional
muscle transfers or immediate tendon transfers were used in four patients. There were
no flap take-backs or failures, and 22 patients achieved independent ambulation. Three
patients in the series died, two from metastatic disease found postoperatively and
one from local recurrence. A 74% response rate was achieved for the TESS survey, with
a mean score of 83.
Conclusion Microsurgical reconstruction of lower extremity sarcoma defects enables preservation
of independent ambulation. Restoration of function utilizing immediate functional
microsurgical reconstructions and tendon transfers should be considered.
Keywords
sarcoma - microsurgery - lower extremity
