gms | German Medical Science

Objectives/Interrogation: Sarcomas are rare tumors that make up roughly 1% of all malignancies, and complete resection remains a mainstay of current treatment guidelines for localized disease. Post-extirpative defects following sarcoma resection often pose a difficult challenge to the reconstructive surgeon. Sarcoma resection commonly results in large soft tissue and/or osseous defects requiring a multitude of reconstructive techniques to restore form and function. Here, we report a single surgeon's experience in upper extremity reconstruction following sarcoma resection.

Methods: An IRB-approved retrospective review of all patients undergoing upper extremity reconstruction by a single surgeon following sarcoma resection at a single institution was conducted.

Results and Conclusions: Between 2015 and 2018, a total of 13 patients were identified as having underwent reconstruction by the senior author following upper extremity sarcoma resection. Our patients consisted of 10 males and 3 females, with an average age of 64.7 yrs (range 54-87) at time of reconstruction. Common comorbidities included hypertension 54%, diabetes 31%, coronary artery disease 23%, and 46% of patients with history of smoking. Types of sarcoma treated include: fibrosarcoma (3), epitheloid sarcoma (3) chondrosarcoma (2), synovial sarcoma (1), osteosarcoma (1), leiomyosarcoma (1), and undifferentiated sarcoma (2). 38% of patients had underwent previous radiation therapy and >50% of patients were undergoing resection of recurrent disease; nearly 25% of patients required post-operative chemoradiation. Immediate reconstruction was performed in 85% patients. Reconstruction options included amputation with concomitant targeted muscle reinnervation (TMR) (38%), free tissue transfer (23%), pedicled tissue transfer, adjacent tissue transfer and skin grafting. Our overall complication rate was 30% (4). Minor complications included neuroma, cellulitis and dehiscence. Major complication requiring reoperation included pseudoaneurysm of recipient vessel requiring vein grafting after a free ALT flap. There were no flap losses. Mean follow-up time was 224 days.

Upper extremity reconstruction following sarcoma resection presents challenging cases, requiring a myriad of reconstructive options. Reconstruction must be tailored for each patient in conjunction with a multidisciplinary team to deliver the patient optimal treatment and reconstruction.