Microvascular Lower Extremity Reconstruction after Oncologic Resection and Revascularization: A Single-Center 21-Year Experience

Abstract

INTRODUCTION: Tumors of the lower extremity necessitating vascular resection and reconstruction increase the complexity of flap reconstruction. We present the reconstructive outcomes of these composite defects at a large center. METHODS: A prospectively maintained database was used to identify patients who underwent lower extremity tumor resection requiring both bony or soft tissue reconstruction and vascular reconstruction. The study included all patients from 2000 to 2021. RESULTS: A total of 18 patients met inclusion criteria. Mean age was 50.1 years (range 15–83) and mean BMI was 26.5 kg/m2 (range 18.5–45.5). Pathology was sarcoma in 14 patients and squamous cell carcinoma in 4 patients. Radiation was given to 11 patients. Vascular reconstruction consisted of prosthetic and autologous grafts. Tissue reconstruction consisted of pedicled muscle flaps in 11 patients and free tissue transfer in 7 patients. Bone resection was performed in 4 patients, of which 3 were reconstructed with metallic implants and 1 with fibula osteocutaneous free flap. Overall complication rate was 61% (11 of 18 patients) and consisted of hematomas in 3 patients, infections in 7 patients, delayed wound healing in 5 patients, and partial flap loss in 1 patient. All patients underwent limb salvage. Mean follow-up duration was 23.89 months (range 1.48 months to 45.8). Functional outcomes were independent ambulation 13 (72.2%) patients, ambulation with assistive devices in 3 (16.6 %) patients and no ambulation in 2 (11.11 %) patients. CONCLUSION: Free flap reconstruction of lower extremity wounds after tumor resection results in excellent rates of limb salvage with good functional outcomes.