Immediate free tissue transfer for distal musculoskeletal neoplasms

Sarcomas and other aggressive neoplasms of the extremities present particular challenges for limb salvage when the tumors are located distally in the arms or legs. These tumors require a large area of excision, yet there are no suitable options for local tissue coverage. In the past, amputation was often necessary due to the inability to adequately reconstruct the extremity. We performed immediate free tissue transfers on 10 patients with aggressive tumors in the forearm and lower leg. Eight patients had sarcomas, 1 had a melanoma, and 1 had a recurrent fibromatosis. Seven patients had rectus abdominis flaps, 1 had a latissimus dorsi flap, 1 had a groin flap, and 1 had an osteocutaneous flap from the iliac crest. Three patients had tendon transfers at the time of surgery. Four patients required radiation therapy after resection due to the high-grade nature of their neoplasms. The flaps tolerated the radiation well, with only 1 patient sustaining flap necrosis that required skin grafting. Average follow-up was 28 months. All patients are alive and none had local recurrences of their tumors. All free flaps have survived and remained durable. There have been no late breakdowns of skin grafts, and all tendon transfers have functioned well. Immediate free tissue transfer provides an excellent method of reconstruction for distal tumors of the extremities.