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

Soft tissue sarcomas (STS) of the foot are rare, accounting for 2-5% of musculoskeletal sarcomas, and are often associated with higher amputation rates due to limited soft tissue coverage, complex anatomy, and the functional demands of weight-bearing. We report the case of a 70-year-old woman with a myxoinflammatory fibroblastic sarcoma involving the 2nd-4th metatarsals. Limb salvage surgery was performed, consisting of en bloc resection with preservation of the metatarso-phalangeal joints, skeletal fixation with titanium plates, tendon reconstruction using tensor fascia lata, and soft-tissue coverage with an anterolateral thigh free flap. Intraoperative, interstitial brachytherapy catheters were placed, enabling 36 Gy/9 fractions safely without wound or flap complications. At 6 months, the patient was disease-free and ambulatory without disability. This case demonstrates that with multidisciplinary planning, complex reconstruction and adjuvant brachytherapy can achieve durable local control and preserve function in selected patients with foot sarcoma.