Free Functional Muscle Transfer following Upper Extremity Sarcoma Resection: A Case Report

Area of Science:

• Orthopedic Surgery
• Reconstructive Microsurgery
• Musculoskeletal Oncology

Background:

• Traditional upper extremity reconstruction relies on tendon or pedicled muscle transfers.
• Gracilis free functional muscle transfer is a viable option for restoring finger flexion.
• High-grade epithelioid sarcoma presents a reconstructive challenge in the forearm.

Observation:

• A 35-year-old male patient with left forearm high-grade epithelioid sarcoma underwent surgical reconstruction.
• An innervated free gracilis transfer was performed to restore finger flexion.
• A secondary profunda artery perforator flap was utilized for soft tissue coverage, using a single donor site.

Findings:

• The patient experienced no postoperative complications.
• At 8-month follow-up, the patient achieved a Musculoskeletal Tumor Score of 22/30.
• Functional outcome, measured by the Quick Disabilities of the Arm, Shoulder, and Hand score, was 34/100.

Implications:

• This case highlights the efficacy of combining gracilis free functional muscle transfer with a profunda artery perforator flap for complex upper extremity reconstruction.
• The single donor-site approach minimizes morbidity.
• Successful restoration of function and soft tissue coverage is achievable in challenging oncological cases.