Soft-tissue coverage of the hand following sarcoma resection

Hand-sparing surgery is now the most common option for sarcomas of the hand. The importance of obtaining widely negative margins has increased the complexity of operations and the importance of soft-tissue and bony reconstruction. The authors review the experience at a single institution of hand reconstruction following sarcoma resection based on prospectively collected data.

Data were collected for all patients undergoing sarcoma resection by a single surgeon. Variables evaluated included patient demographics, tumor pathologic findings, location, size, depth, grade, stage, method of resection and reconstruction, adjuvant therapies, complications, and patient outcomes.

Fifty-five patients (30 male and 25 female) fulfilled eligibility criteria. The median age was 36 years (range, 1 to 80 years). The most common abnormalities were epithelioid sarcoma (n = 9), soft-tissue malignant fibrous histiocytoma (n = 8), synovial sarcoma (n = 6), and fibrosarcoma (n = 4). Flap reconstructions were required in 27 patients. The most common reconstruction method was a finger fillet flap in eight patients, followed by the radial forearm flap in five patients and the gracilis flap and skin grafting in three patients each. A suboptimal biopsy before presentation was strongly predictive of the need for flap reconstruction (p < 0.001). Nine patients had complications (delayed healing or skin necrosis, fracture, nonunion, epidermolysis, and tendon adhesion). No microvascular complications occurred.

The choice of hand reconstruction method following sarcoma resection depends on a complete knowledge of options, risks, and benefits. Extensive use of a limited number of techniques by the authors' institution appears to contribute to excellent success and complication rates, with safe, reliable, and effective soft-tissue coverage.