A reconstructive algorithm after thigh soft tissue sarcoma resection including predictors of free flap...

Area of Science:

• Orthopedic Oncology
• Plastic and Reconstructive Surgery
• Limb Salvage Surgery

Background:

• Reconstruction of thigh defects post-oncologic resection is crucial for limb salvage.
• Thigh sarcomas present unique reconstructive challenges.
• Evidence-based guidelines are needed for optimal reconstructive strategies.

Purpose of the Study:

• To evaluate institutional experience with thigh sarcoma reconstruction.
• To identify factors predicting the need for free flap reconstruction.
• To develop recommendations for reconstructive surgeons.

Main Methods:

• Retrospective review of 159 thigh reconstructions following sarcoma resection (1997-2014).
• Analysis of patient demographics, comorbidities, therapies, and operative characteristics.
• Evaluation of reconstructive techniques including primary closure, skin grafts, local/regional flaps, and free flaps.

Main Results:

• Reconstruction utilized primary closure (15%), skin grafts (13%), local fasciocutaneous flaps (8%), local muscle flaps (31%), regional muscle flaps (28%), and free flaps (4%).
• Proximal thigh defects favored pedicled thigh muscle and rectus abdominis flaps; middle third favored pedicled thigh muscle flaps; distal third favored pedicled gastrocnemius flaps.
• Wide defects (p=0.03) and middle third thigh location (p=0.001) predicted the need for free flap reconstruction.

Conclusions:

• Multiple reconstructive options exist for thigh soft tissue sarcoma (STS) defects.
• Pedicled local or regional muscle/fasciocutaneous flaps are suitable for most defects when primary closure/grafts fail.
• Free flap reconstruction is infrequently required but essential for wide or middle-third thigh defects.