Free vascularised tissue transfer and brachytherapy for soft-tissue sarcomas of the extremities

We reviewed the medical files of nine patients with localised soft-tissue sarcomas of the extremities treated with surgical resection, free vascularised tissue transfer, and computerised after-loading iridium-192 high dose rate brachytherapy over a period of 8 years. All patients had external beam radiation therapy in fractions with a total dose of 48-52 Gy, followed by surgery at approximately 4-5 weeks post-irradiation. Surgical treatment included wide resection of the primary tumour in six patients, and marginal resection in three patients. Microsurgical reconstruction of the soft-tissue defect used a free vascularised musculocutaneous flap that included the gracilis flap in five patients, the latissimus dorsi flap in four patients, and the radiovolar flap in one patient. Postoperative brachytherapy dose ranged from 12 to 24 Gy. Adjuvant chemotherapy was administered in five patients with large tumours and marginal resection. At a mean follow-up of 36 months, eight patients were still alive with no evidence of local recurrence or distant metastases; all these patients had good cosmetic and functional outcomes. Two patients died with lung metastases; one of these patients had local tumour recurrence. Wound healing problems and seroma formations were observed in two patients. Intramedullary nailing was required in one patient for a pathological fracture. Tumour resection for soft-tissue sarcomas combined with microsurgical reconstruction of the soft-tissue defect, preoperative external beam radiation and high dose rate brachytherapy results in a high degree of local control with acceptable complications.