Spare part reconstruction in sarcoma surgery: The benefits of giving a purpose to what would otherwise be discarded

Limb sarcomas are rare, comprising 1% of adult cancers. Previously treated mainly via amputation, multimodal therapies now favor limb-salvage surgery without compromising survival. Wide resection margins remain essential, and amputations are sometimes required. In such cases, uninvolved distal limb tissues can be used as fillet flaps for reconstruction, optimizing prosthetic fitting and minimizing morbidity. This study reviewed a 11-year case series of spare part reconstruction after sarcoma surgery and provides useful surgical insights.

A retrospective review of patients who underwent spare part reconstruction after sarcoma surgery between 2014 and 2025 was conducted. Fifteen patients (mean age, 36.3 years) were collected. Resections included 5 forequarter amputations, 2 hip disarticulations, 1 external hemipelvectomy, 5 intercalary knee resections, and 2 intercalary tibial resections. Five upper limb fillet flaps, 4 lower limb fillet flaps, 1 hip rotationplasty, and 5 knee rotantioplasties were performed.

All 15 flaps survived and 6 patients had complications. Nine patients were alive at the end of the study: 8 showed no evidence of disease and 1 presented oncologic progression. Six patients died within 43 months after surgery (mean, 26.7 months). Mean disease-free survival after surgery was 10.4 months. Prosthesis-fitting occurred after 4 months on an average. Mean follow-up was 37.2 months.

Fillet flaps are a valuable option for reconstruction after complex sarcoma resections. These flaps are oncologically safe and provide high-quality tissue with no additional donor site morbidity. Successful outcomes depend on careful patient selection and management by an experienced multidisciplinary team.