Microsurgical reconstruction in limb-salvage procedures: comparison between primary and secondary reconstruction

Limb-salvaging procedures after malignant tumor resection in the extremities were performed in 22 cases, utilizing microsurgical tissue transplantation. Five patients had soft-tissue tumors and 17 had bone tumors. Thirteen cases were primarily and nine were secondarily reconstructed. The advantages and disadvantages of both primary and secondary reconstructions were compared: as to technical difficulty, primary reconstruction was much easier. Chemotherapy was necessary just before and/or after reconstruction in eight of 13 cases of primary reconstruction. Delayed union or non-union occurred more frequently in patients who required chemotherapy, but eventual union was achieved in all cases by adding a conventional bone graft. As for oncologic and functional status, there was no difference in oncological status between the primary and secondary groups, but the primary reconstructions showed better functional results. Although individualized treatment is of utmost importance when utilizing microsurgical reconstruction to save limbs, primary reconstruction can be done most successfully when there is a wide surgical margin after tumor resection and when attention is paid to the avoidance of such complications as delayed union or non-union.