Functional outcome following upper limb soft tissue sarcoma resection with flap reconstruction.

Area of Science:

• Orthopedic Oncology
• Surgical Reconstruction
• Musculoskeletal Tumors

Background:

• Soft tissue sarcoma resection in the upper limb frequently necessitates flap reconstruction to preserve limb function.
• This study evaluates functional outcomes after sarcoma resection and reconstruction in the shoulder, elbow, or wrist/hand regions.

Purpose of the Study:

• To compare pre- and post-operative upper limb function in patients undergoing sarcoma resection and soft tissue reconstruction using pedicled versus free flaps.
• To analyze functional outcomes based on the location of sarcoma resection (shoulder, elbow, wrist/hand).

Main Methods:

• A retrospective study of 113 patients who underwent upper limb soft tissue sarcoma resection and flap reconstruction between 1989 and 2008.
• Functional outcomes were assessed using the Toronto Extremity Salvage Score (TESS) and the Musculoskeletal Tumour Society Rating Scale (MSTS).
• Perioperative morbidity, mortality, flap loss, and the relationship between flap type and functional scores were analyzed.

Main Results:

• No significant differences in post-operative MSTS or TESS scores were observed between pedicled and free flap groups.
• Significant pre- to post-operative improvements in MSTS scores were noted for both pedicled and free flap reconstructions.
• Post-operative score reductions were primarily associated with resection of major joints, nerves, tendons, or muscle groups.

Conclusions:

• Both pedicled and free flap reconstructions provide satisfactory maintenance of upper limb activity following sarcoma resection.
• Patient-reported function (TESS) indicated better outcomes compared to objective impairment measures (MSTS).
• Flap choice does not significantly impact overall functional outcome, but specific anatomical resections influence post-operative scores.