Abstract
Background Limb-salvage surgery combined with radiotherapy has become the primary treatment for soft tissue sarcomas of the extremity. Free functional latissimus flaps (FFLF) are an option to restore function in the setting of volumetric muscle loss. The purpose of the current study was to examine the use of FFLF in patients undergoing resection of thigh sarcoma. Methods Twelve patients with a sarcoma involving the hamstring (n = 6), quadriceps (n = 5), or combined (n = 1) defects which included multiple muscle groups were reviewed. This included 9 males and 3 females with a mean age and body mass index of 56 ± 12 years and 31.3 ± 5.7 kg/m2. Results The mean defect volume and operative time was 3,689 ± 2,314 cm3 and 587 ± 73 minutes. Following reconstruction, the mean knee range of motion (ROM), MSTS93 score, and muscle strength was 89 ± 24°, 90 ± 15%, and 4 ± 1; with 75% of patients ambulating without gait aids. Seven (58%) patients sustained a complication, namely, delayed wound healing (n = 2). Conclusion Although there was a high incidence of complications, FFLF can restore active knee ROM and function, with most patients ambulating without gait aids following reconstruction of large oncologic defects in the thigh.
Highlights
Advances in surgical techniques and the addition of neo adjuvant or adjuvant radiotherapy have allowed limbsalvage surgery to become the primary means of treatment for patients with nonmetastatic soft tissue sarcomas of the extremities [1]
Following resection of a primary soft tissue sarcoma, or in the setting of a reexcision of a previous inadvertent excision, reconstructive surgeons are often faced with volumetric muscle loss, with limited options for functional reconstruction [3,4,5]
Following traumatic injuries to the upper and lower extremity, free functional muscle flaps have become popular to restore function [9,10,11,12]; there are limited data on the use of these flaps in the oncologic setting to provide coverage with potential space obliteration, in addition to a functional reconstruction [13]. e purpose of this study was to review our institutions experience with free functional latissimus dorsi muscle flaps to restore either quadriceps or hamstring function following oncologic resection
Summary
Limb-salvage surgery combined with radiotherapy has become the primary treatment for soft tissue sarcomas of the extremity. Free functional latissimus flaps (FFLF) are an option to restore function in the setting of volumetric muscle loss. E purpose of the current study was to examine the use of FFLF in patients undergoing resection of thigh sarcoma. Twelve patients with a sarcoma involving the hamstring (n 6), quadriceps (n 5), or combined (n 1) defects which included multiple muscle groups were reviewed. The mean knee range of motion (ROM), MSTS93 score, and muscle strength was 89 ± 24°, 90 ± 15%, and 4 ± 1; with 75% of patients ambulating without gait aids. There was a high incidence of complications, FFLF can restore active knee ROM and function, with most patients ambulating without gait aids following reconstruction of large oncologic defects in the thigh
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