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Total Quadriceps Resection in High-Grade Soft-Tissue Sarcomas of the Thigh: Surgical Technique and Long-Term
Luis Rafael Ramos Pascua1,2,3, Paula Casas Ramos4, Rubén Álvarez García5,6
1Department of Trauma and Orthopaedics Surgery, University Hospital 12 de Octubre, Av/Córdoba, s/n, Usera, 28041 Madrid, Spain.
Background:
Reconstruction of the thigh extensor mechanism following wide excision of a soft-tissue sarcoma is difficult. The aim of this study was to describe the outcomes following complete quadriceps resection for large high-grade soft-tissue sarcomas.
Methods:
Ten patients with AJCC grade IIIB soft-tissue sarcomas of the anterior thigh were treated with total wide margin quadricectomy, with a mean follow-up of 4 years (range: 51-163 months) in the five surviving patients with conservative surgical procedures. The minimum follow-up period for four of these patients was 8 years. The extensor mechanism was reconstructed with local muscle transfers (eight cases) or a neurotized free flap of the contralateral vastus lateralis (two cases).
Results:
Four patients died, two due to non-tumor related causes and two due to metastatic disease at 50 months and 43 months. The remaining six were alive and disease-free at the final follow-up. All patients received surgical revision due to wound necrosis. Another patient required an external hemipelvectomy due to early local recurrence of the disease. Functional results of the five patients who remained alive and retained their limb were good or excellent in two cases, acceptable in one, and poor in two, according to their MSTS scores. Average knee flexion was 80° (range: 10-150°). Passive extension was complete in all cases, though no patients achieved it actively. Extensor strength was 2/5 in four patients and 4/5 in the other.
Conclusion:
Total quadricectomy for high-grade soft-tissue sarcomas of the anterior thigh compartment ensures wide resection margins and local disease control, although local wound complications are common, particularly in older patients. Resection appears to be technically easier if performed distally to proximally in the thigh. Local muscle transfers are more suited for low-demand patients, while neurotized free muscle flaps are mainly an option for young, motivated patients.
