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J Reconstr Microsurg 2019; 35(03): 168-175
DOI: 10.1055/s-0038-1668116
Original Article
Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

Patient Reported Outcomes Following Lower Extremity Soft Tissue Sarcoma Resection with Microsurgical Preservation of Ambulation

Ian R. MacArthur
1   Department of Surgery, Section of Plastic Surgery, University of Manitoba, Winnipeg, MB, Canada
,
Colin W. McInnes
1   Department of Surgery, Section of Plastic Surgery, University of Manitoba, Winnipeg, MB, Canada
,
Kim R. Dalke
1   Department of Surgery, Section of Plastic Surgery, University of Manitoba, Winnipeg, MB, Canada
,
Mohamed Akra
2   Department of Radiation Oncology, University of Manitoba, Winnipeg, MB, Canada
,
Shantanu Banerji
3   Department of Internal Medicine, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada
4   Department of Medical Oncology and Hematology, CancerCare Manitoba, Winnipeg, Manitoba, Canada
,
Edward W. Buchel
1   Department of Surgery, Section of Plastic Surgery, University of Manitoba, Winnipeg, MB, Canada
,
Thomas J. Hayakawa
1   Department of Surgery, Section of Plastic Surgery, University of Manitoba, Winnipeg, MB, Canada
› Author Affiliations
Further Information

Publication History

11 January 2018

08 July 2018

Publication Date:
18 August 2018 (online)

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Abstract

Background Lower extremity soft tissue sarcoma treatment has evolved from primarily amputation procedures toward limb salvage. This series assesses whether soft tissue sarcoma tissue defects, extensive enough to require microsurgical reconstruction, can reliably result in preservation of ambulation, as well as objectively evaluate functional outcomes utilizing a patient-reported validated scale. It will also look at whether immediate functional muscle reconstructions and tendon transfers can be successful at restoring ambulation, potentially expanding the indications for limb salvage procedures.

Methods A retrospective review of all microsurgical reconstructions for limb salvage in lower extremity sarcoma patients was completed at our institution (2009–2013). Patients were additionally asked to complete the Toronto Extremity Salvage Score(TESS) quality of life survey.

Results Over a 5-year period, 23 patients (mean age: 53 years) underwent free flap reconstructions for 23 sarcomas (mean follow-up: 14 months). Seventy-eight percent of patients received neoadjuvant radiation. The thigh was the most common tumor site (61%) and three muscles were resected on average. Perforator flaps were most frequently used (61%), and functional muscle transfers or immediate tendon transfers were used in four patients. There were no flap take-backs or failures, and 22 patients achieved independent ambulation. Three patients in the series died, two from metastatic disease found postoperatively and one from local recurrence. A 74% response rate was achieved for the TESS survey, with a mean score of 83.

Conclusion Microsurgical reconstruction of lower extremity sarcoma defects enables preservation of independent ambulation. Restoration of function utilizing immediate functional microsurgical reconstructions and tendon transfers should be considered.

Keywords

sarcoma - microsurgery - lower extremity
 

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