Preserving a Functional Foot: Limb-Salvage Surgery with Brachy Mono-Therapy for Soft Tissue Sarcoma

Area of Science:

• Orthopedic Oncology
• Surgical Oncology
• Reconstructive Surgery

Background:

• Soft tissue sarcomas (STS) of the foot are rare, comprising 2-5% of musculoskeletal sarcomas.
• STS of the foot often necessitate amputation due to anatomical complexity and functional demands.
• Myxoinflammatory fibroblastic sarcoma is an uncommon subtype of STS.

Purpose of the Study:

• To present a case of successful limb salvage surgery for a rare foot sarcoma.
• To demonstrate the feasibility of complex reconstruction and adjuvant brachytherapy in managing foot STS.
• To highlight the importance of multidisciplinary planning in achieving functional preservation and local control.

Main Methods:

• En bloc resection of a myxoinflammatory fibroblastic sarcoma involving the 2nd-4th metatarsals.
• Limb salvage surgery including preservation of metatarso-phalangeal joints, skeletal fixation with plates, tendon reconstruction, and free flap coverage.
• Intraoperative placement of interstitial brachytherapy catheters for adjuvant radiation therapy (36 Gy/9 fractions).

Main Results:

• The patient underwent successful en bloc resection and complex reconstruction.
• Adjuvant brachytherapy was safely delivered without wound or flap complications.
• At 6 months post-surgery, the patient was disease-free and ambulatory without disability.

Conclusions:

• Complex reconstruction combined with adjuvant brachytherapy can achieve durable local control for selected foot sarcomas.
• Limb salvage surgery is a viable option for foot STS, preserving function and avoiding amputation.
• Multidisciplinary collaboration is crucial for optimizing outcomes in rare and complex oncological cases of the foot.