Reconstruction par lambeaux libres dans les sarcomes localement évolués

Abstract

Study aim: The aim of this retrospective study was to assess the advantages of free-lap reconstruction in locally advanced soft tissue sarcomas. Patients and method: From October 1997 to October 2000, among 256 procedures for sarcomas, 25 were associated with free-lap reconstruction. There were 16 women and nine men (mean age: 45 years). The tumor was located on inferior limbs ( n= 15), superior limbs ( n = 3) and trunk ( n = 7), had a mean size of 12, 10 and 12 cm respectively, and was multifocal ( n = 6), or recurrent ( n = 10). Ten patients received a neoadjuvant chemotherapy. Tumoral excision was associated with a complementary procedure in 10 patients. Reconstruction was performed with free-laps of the latissimus dorsi ( n = 21) and transverse rectus abdominis myocutaneous (TRAM) ( n = 4). Early postoperative radiotherapy was associated in 15 patients. Results: Median duration of the procedure was 6.5 hours. There were no postoperative deaths. Two free-laps necrotized and another free-lap was constructed. Tumoral excision was R 0 ( n = 20), R 1 ( n = 4) and R 2 ( n = 1). With a median follow-up of 20 months, there were no local recurrences in patients R 0. Ten patients developed pulmonary metastases and five of them died. Conclusion: With free-lap reconstruction, tumoral excision was larger, amputation of the limb was avoided in 14 patients, and early postoperative radiotherapy was possible in 15 patients. Multidisciplinary management and collaboration of the oncologist and plastic surgeon are associated with a better prognosis of locally advanced soft tissue sarcomas.