Functional reconstruction of sarcoma defects utilising innervated free flaps

Area of Science:

• Oncology
• Plastic Surgery
• Orthopedic Surgery

Background:

• Soft-tissue reconstruction after sarcoma treatment, especially with preoperative radiotherapy, presents significant challenges.
• Pedicled and free tissue transfers are crucial for limb-sparing surgery in sarcoma patients.

Purpose of the Study:

• To evaluate the efficacy of one-stage innervated free or pedicled musculocutaneous flap transfers for soft-tissue reconstruction post-sarcoma resection.
• To assess functional outcomes, including range of motion and muscle strength, in patients undergoing such reconstructions.

Main Methods:

• Retrospective review of 22 patients with soft-tissue sarcoma treated with radiotherapy, wide excision, and subsequent flap reconstruction.
• Flap types primarily included latissimus dorsi and gracilis.
• Reconstructions were performed for upper limb, lower limb, and abdominal wall defects.

Main Results:

• Full range of motion was restored in 14 patients.
• Muscle strength achieved was grade 4 or 5 in all but one patient.
• Excellent overall function was observed, with functional scores of 71.2% for the upper limb and 84% for the lower limb.
• Two major complications (flap necrosis) occurred, both successfully revised.

Conclusions:

• Innervated flaps are effective for reconstruction after sarcoma resection in extremities and the abdominal wall.
• The study demonstrates encouraging functional results, supporting the use of innervated muscle reconstruction in sarcoma treatment protocols.
• This technique is a valuable alternative for improving patient outcomes following oncological resection and radiotherapy.